Help w/ specialty choice

[asrw77]

I'm an MS3, trying to do some exploration of specialties. Step 1 >260, good medical school, multiple pubs in process and research-oriented, so in theory any specialty should be possible. There's a list of things I think that I want, and 3 specialties I am most interested in right now, wondering if anyone has any thoughts or insight.

Things I am looking for:

• Work with hands (doesn't have to be big open surgery, minimally invasive stuff can be pretty elegant)
• Expert in my field, excellence
• Variety of pathology, patient population, presentations
• Rapidly innovative field with impactful basic, translational, clinical research opportunities
• Meaningful patient interactions by which I mean patients present with a problem and generally am able to offer solutions with good outcomes and the patients are grateful
• Use and interpretation of imaging
• Good pay

Right now my running list is neurosurgery, ENT, IR/DR. Any other specialties I should consider? Any advice for choosing between these? I'm a little hesitant about neurosurgery lifestyle to be perfectly honest, and length of training (although ENT and IR/DR are 5-7 years anyways so I guess the difference here is not huge). Anybody have any insights they can offer? TIA

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[Chelsea FC]

The fact that lifestyle wasnt really in ur list of needs I would just go with the field with the most pay and u can tolerate the most. U can get a little bit of all u list in every field but rarely u will get all. Overall ENT and Neurosurgery might be the best "fit" based on ur list but depending on ur practice u will see that u wont get it all. Dont think IR docs are Expects in their field but again this is hospital dependent where I am at they get most of the procedures no one else want to do. I think Surge Onc and other surgery fields should be on ur list.

 

[Neopolymath]

ENT or Uro

 

[Dral]

Look into Ortho. I think the patient population can be a bit limited depending on what you do, but the way I understand it, they can have a huge fairly quick impact on patients. It relies a lot on imaging. There are translational opportunities with artificial components. You work with your hands. You can be an expert in the field. Good pay.

The only thing it may fall a bit short on (and I don't think it necessarily has to) is the variety of path/patients/presentations. I'm not in ortho, but maybe someone who is can give better insight on that.

 

[operaman]

Really can’t go wrong with anything on your list honestly. Would definitely add Ortho and Ophtho to your list. Everything but nsgy offers fantastic lifestyle options, and some private nsgy jobs can offer some more tolerable lifestyle options. Anything procedural is more insulated from Midlevel encroachment as well.

For ENT the job market has been fairly robust, though last year was a bit weird with covid and hiring freezes and the like. I was pretty picky and had good options and landed an incredible position. With only 300 new grads annually it seems to keep a nice balance with the number of retirements. Our national organizations are also very protective so I don’t foresee a bunch of new programs popping up and screwing everyone like we’ve seen in EM.

I’ll add another thing for ENT, ophtho, and rads - there are lots of ways to continue practicing as you get older. ENT generates much of their revenue in clinic so there are a number of docs who continue working non-op positions. I have a couple partners who do this and it’s awesome for young guys like me since they screen out a lot of fluff and send you good operative cases already worked up and ready. I know we all hope and plan to retire early and be set, but life often has other plans so always good to keep options open.

 

[giguerex35]

may not pay as much as the otehr fields listed but OB really could meet all of these. The OB i am currently working with is the head of a clinical trial for OB related surgery, so research and hands on work all in one these. You can also get really good with US for the imaging and interpretation aspect. Excellence is really all on you regardless of the field, now if you really mean you want prestige and people to bow down then OB prob isn't that. You can also help many pts easily and the outcomes i would say a pretty good compared to some surgical fields. Pts are 50/50 on being grateful tho so take that with a grain of salt.

 

[Splenda88]

ENT, maybe Ophtho

 

[mpp]

Neurosurgery ticks the boxes on your list. The road is long but the lifestyle is not as bad as most make it out to be (but it ain’t dermatology). As a mid-career neurosurgeon I do see the younger ones coming out of training expecting more for less which I guess just means that “lifestyle” is subjective. Or maybe it’s just me being an old man…”you think you have it hard” kind of stuff. Either way, I wouldn’t change my career choice for any other in medicine.

 

[Chads2]

With lifestyle not being weighed heavily, and using the criteria you presented, I would have to suggest Surgical Oncology. I feel like it checks off the boxes you listed above.

 

[Ttubule]

I would definitely add ortho to your list. I really only have a peripheral knowledge of the other fields but in terms of offering great outcomes I think that’s what attracts many of us to the field. There’s very few happier patients than someone with a total hip that can walk fairly pain free the day of surgery after years of crippling arthritis.
Someone else mentioned the limited patient population, and probably skew more geriatric, but depending on your sub specialty you’ll work with a wide range of people. I don’t think the ortho “jock who did well on standardized tests” stereotype is born in a vacuum (I fit the bill), but there are TONS of people in ortho who are not that at all. There’s robust areas of cutting edge research going on all the time, plenty of attendings I work with run their own basic science labs.
Something to think about. Ortho is much more than just hips and knees. What a hand surgeon does on a day to day basis is much different than a peds scoliosis surgeon which is much different from an adult recon guy.

 

[Angus Avagadro]

I would not suggest rads, lifestyle sucks and mostly cubicle work focusing on productivity. Some of the hardest med Mal cases to defend. Lawyers just play Where's Waldo? Waldo is easy to find on earlier scans after a later scan reveals an obvious abnormality. Your other choices sound great.

 

[GadRads]

I would not suggest rads, lifestyle sucks and mostly cubicle work focusing on productivity. Some of the hardest med Mal cases to defend. Lawyers just play Where's Waldo? Waldo is easy to find on earlier scans after a later scan reveals an obvious abnormality. Your other choices sound great.

Are you a radiologist?

 

[ACSurgeon]

if you wanna be an expert in your field prepare to do a fellowship and maybe even a second fellowship and spend the first 5-10 years of your life as an attending working really hard and trying to produce literature in the field. Otherwise, you’ll be good at your job but hardly an expert. so, length of training and hard work should be assumed no matter which specialty.

regarding lifestyle: your goals might change if you have kids in the next 10 years. Be careful of having the “badass” approach and think you don’t care about lifestyle because that very well could change in the future.

Regarding pay: all surgical fields have potential for high pay, and can also pay you a fraction of what your worth. If you want to be an academic expert, get ready to make 50-60% of what you could get paid at the community hospital across the street. I’m sure exceptions exist but keep this in mind as a possibility so you’re not disappointed later on. At some point academic physicians make “good” money, but the good old days of having academic perks are gone. Sure you’ll have residents or fellows offloading your call but you still have to come in for cases etc. retirement benefits aren’t what they used to be either.

In summary, don’t let your high achievement thus far push you to become something you’re not truly interested in. Find the specialty that fits your clinical and academic interests and go from there. General surgery with a fancy surg onc or peds fellowship is no less glamorous than urology or ENT. Just find what you truly like.

 

[Angus Avagadro]

Are you a radiologist?

I am not. I have several very close friends who are. I do feel very comfortable about commenting on the field In fact, our top 20 local uni med school with over 100 graduating students only matched ONE student in diagnostic radiology this year.☹

 

[odyssey2]

I am not. I have several very close friends who are. I do feel very comfortable about commenting on the field In fact, our top 20 local uni med school with over 100 graduating students only matched ONE student in diagnostic radiology this year.☹

Are you saying students at top med schools are avoiding the field in general?

 

[Matthew9Thirtyfive]

I am not. I have several very close friends who are. I do feel very comfortable about commenting on the field In fact, our top 20 local uni med school with over 100 graduating students only matched ONE student in diagnostic radiology this year.☹

I have a few friends who are radiologists who love their jobs and highly recommend it. I don’t know any radiologists who recommend avoiding the field.

 

[Dave1980]

I would not suggest rads, lifestyle sucks and mostly cubicle work focusing on productivity. Some of the hardest med Mal cases to defend. Lawyers just play Where's Waldo? Waldo is easy to find on earlier scans after a later scan reveals an obvious abnormality. Your other choices sound great.

Please take this guy with a grain of salt. I WFH 3 days a week, 8 weeks of vacation, 8 weekends a year, salaried at just under 500k this year. We work hard during the workday but we all clock in at 8 and clock out at 5

 

[Cognovi]

Please take this guy with a grain of salt. I WFH 3 days a week, 8 weeks of vacation, 8 weekends a year, salaried at just under 500k this year. We work hard during the workday but we all clock in at 8 and clock out at 5

OP is looking for manual labor and patient gratitude, which would suggest that lifestyle is less of a concern.

 

[Cognovi]

I'm an MS3, trying to do some exploration of specialties. Step 1 >260, good medical school, multiple pubs in process and research-oriented, so in theory any specialty should be possible. There's a list of things I think that I want, and 3 specialties I am most interested in right now, wondering if anyone has any thoughts or insight.

Things I am looking for:

• Work with hands (doesn't have to be big open surgery, minimally invasive stuff can be pretty elegant)
• Expert in my field, excellence
• Variety of pathology, patient population, presentations
• Rapidly innovative field with impactful basic, translational, clinical research opportunities
• Meaningful patient interactions by which I mean patients present with a problem and generally am able to offer solutions with good outcomes and the patients are grateful
• Use and interpretation of imaging
• Good pay

Right now my running list is neurosurgery, ENT, IR/DR. Any other specialties I should consider? Any advice for choosing between these? I'm a little hesitant about neurosurgery lifestyle to be perfectly honest, and length of training (although ENT and IR/DR are 5-7 years anyways so I guess the difference here is not huge). Anybody have any insights they can offer? TIA

"Expertise in your field" usually means being a body system clinical specialist, while "variety of pathology" is usually counter to that. The only exceptions are the specialities that are first defined by their tools rather than the disease or body part, like radiology, pathology, and anesthesiology. (Radiation oncology is also defined by the tools but also limited to cancer pathology.) The neurosurgeons want nothing to do with the patient's nose issue. The ENTs don't know anything about the patient's brain issue. Who can tell you something about both? The radiologist (especially the neuroradiologist here). The radiologist is a generalist to the specialist, and also a specialist to the generalist -- people who identify problems for the primary care and emergency physician and become the portal to a referral to another subspecialist. Subspecialty-trained radiologists are also specialists to specialists -- consultants on imaging to the disease/body part experts.

Radiology won't often get you patient gratitude, but you will get physician gratitude. You're the doctor's doctor. The doctor comes to you with a patient's problem and you are generally able to offer an answer that helps guide further management, or an intervention that can avoid a surgery.

 

[Angus Avagadro]

Are you saying students at top med schools are avoiding the field in general?

At least at ours.

 

[Angus Avagadro]

I have a few friends who are radiologists who love their jobs and highly recommend it. I don’t know any radiologists who recommend avoiding the field.

Must be regional. I can name about a dozen. Our state has some of the lowest reimbursement rates from CMS in the country, like 45th out of 50 states. Recruiting is the major obstacle for us. So understaffed radiologists are pretty unhappy. Residents won't stay in the area. You can cross any state line that borders our state and get a salary increase. The 500k 3 day work some enjoy won't last long. The only people we can recruit have ties, usually family to the area, and they are few and far between.

 

[Cognovi]

At least at ours.

Number of radiology matches among graduating MD students at top medical schools 2021:

• Harvard: 3 DR of 159
• WashU: 7 DR of 105
• Hopkins: 4 DR, 1 IR of 119
• Penn: 4 DR, 2 IR of 147
• NYU: 5 DR, 1 IR of 110
• Duke: 5 DR, 4 IR of 109
• Columbia: 7 DR, 1 IR of 142
• UWashington: 5 DR, 3 IR of 280

Couldn't find match lists for UCSF and Stanford but I know at least one from each.

Considering about 4% of US MDs enter radiology overall, these figures do NOT support the hypothesis that students at top med schools are avoiding the field in general.

 

[Matthew9Thirtyfive]

Must be regional. I can name about a dozen. Our state has some of the lowest reimbursement rates from CMS in the country, like 45th out of 50 states. Recruiting is the major obstacle for us. So understaffed radiologists are pretty unhappy. Residents won't stay in the area. You can cross any state line that borders our state and get a salary increase. The 500k 3 day work some enjoy won't last long. The only people we can recruit have ties, usually family to the area, and they are few and far between.

Then that sounds like an extremely regional problem and a reason to avoid your area rather than radiology.

 

[Dave1980]

Must be regional. I can name about a dozen. Our state has some of the lowest reimbursement rates from CMS in the country, like 45th out of 50 states. Recruiting is the major obstacle for us. So understaffed radiologists are pretty unhappy. Residents won't stay in the area. You can cross any state line that borders our state and get a salary increase. The 500k 3 day work some enjoy won't last long. The only people we can recruit have ties, usually family to the area, and they are few and far between.

There never has and never will be 500k 3 day work weeks in rads but IMO it still is by far the best field in medicine

 

[Angus Avagadro]

There never has and never will be 500k 3 day work weeks in rads but IMO it still is by far the best field in medicine

Wait..what? Didn't you say in a post above that you worked from home 3 days a week had 8 weeks off and made just under 500k? Or did I misread/ misunderstand?

 

[Wolvvs]

Wait..what? Didn't you say in a post above that you worked from home 3 days a week had 8 weeks off and made just under 500k? Or did I misread/ misunderstand?

I think Dave meant 3 of their work days per week were from home, not that the work was exclusively from home. At least that's how I read it?

 

[Dave1980]

Wait..what? Didn't you say in a post above that you worked from home 3 days a week had 8 weeks off and made just under 500k? Or did I misread/ misunderstand?

home 3 days a week. hospital 2 days a week.

 

[Angus Avagadro]

home 3 days a week. hospital 2 days a week.

Thanks for clarifying

 

[deleted1064759]

Please take this guy with a grain of salt. I WFH 3 days a week, 8 weeks of vacation, 8 weekends a year, salaried at just under 500k this year. We work hard during the workday but we all clock in at 8 and clock out at 5

With this in mind, why don't more people go for radiology over, say, dermatology? Does the fear of AI contribute to this?

 

[Dave1980]

With this in mind, why don't more people go for radiology over, say, dermatology? Does the fear of AI contribute to this?

There are numerous legit reasons not to go into radiology. i do think we work harder than most doctors when we are on the clock and for the most part we don't see patients (which for most of us is good!).

if you don't go into radiology bc of AI I think you are probably also eating Ivermectin instead of getting a vaccine.

 

[Cognovi]

Does the fear of AI contribute to this?

Fear of AI probably contributes a little bit. Medical students are uninformed or underinformed about many specialties, particularly specialties like radiology where only a minority of students rotate in it clinically. The particulars of the performance and clinical implementation of AI, and how that interacts with the complexity of clinical practice, is certainly going to be beyond the understanding of the vast majority of medical students. In the setting of ignorance and lack of exposure, uncertainty fills the void, as does perception driven by nonradiologist physicians and lay media. Why don't med students talk about AI applied to skin photographs in dermatology, retinal photographs in ophthalmology, electro- and echocardiograms in cardiology, histology slides in pathology, etc? What about midlevel scope creep in anesthesiology, emergency medicine, and many other fields?

 

[Lawpy]

There are numerous legit reasons not to go into radiology. i do think we work harder than most doctors when we are on the clock and for the most part we don't see patients (which for most of us is good!).

if you don't go into radiology bc of AI I think you are probably also eating Ivermectin instead of getting a vaccine.

What if people go into radiology bc of AI?? AI is exactly the reason why rads is looking popular to me

 

[Lawpy]

In before bot!Lawpy conspiracy theories resurface

 

[Cognovi]

With this in mind, why don't more people go for radiology over, say, dermatology? Does the fear of AI contribute to this?

News flash, more people do choose radiology over dermatology.

2021 NRMP number of matches of US MD seniors (for PGY-1 [categorical] + PGY-2 [advanced] positions):

• Dermatology: 407
• Radiology: 741 DR, 127 IR/DR, 1 DR/NM

2021 NRMP number of matches total (for PGY-1 [categorical] + PGY-2 [advanced] positions):

• Dermatology: 501
• Radiology: 1097 DR, 155 IR/DR, 2 DR/NM

 

[Dave1980]

What if people go into radiology bc of AI?? AI is exactly the reason why rads is looking popular to me

IMO going into rads for AI makes almost as much sense as not going into it because of AI.

At best AI will merely streamline the process of creating a report. it wont fundamentally change what radiology is like

 

[Neopolymath]

In before bot!Lawpy conspiracy theories resurface

I'm on to you.

 

[esob]

I recommend figuring out what you like when you get to a rotation (same old lame comment, I know). But, the truth is, you can adapt most of the things on your "want" list to some specialities that you might not even be considering. For a wild example, if you throw in a 1-year interventional psychiatry fellowship, you can hit everything on your list. So, although it may seem cliche, I would figure out what rotation makes you excited to go into the hospital in the morning and THEN talk with some physicians in that field to figure out if there is some incarnation of that speciality that fits your list.

 

[Dave1980]

I recommend figuring out what you like when you get to a rotation (same old lame comment, I know). But, the truth is, you can adapt most of the things on your "want" list to some specialities that you might not even be considering. For a wild example, if you throw in a 1-year interventional psychiatry fellowship, you can hit everything on your list. So, although it may seem cliche, I would figure out what rotation makes you excited to go into the hospital in the morning and THEN talk with some physicians in that field to figure out if there is some incarnation of that speciality that fits your list.

interventional psych?!?!??!?

never heard of it and neither has google.

 

[calivianya]

What if people go into radiology bc of AI?? AI is exactly the reason why rads is looking popular to me

I definitely know people going into rads for AI.

I've met multiple people who talked about some of their undergrad and/or med school research being in creating neural networks and a whole bunch of other AI crap I don't understand at all, and that's a reason they really like radiology. They want to be on the cutting edge of new AI technology and they see potential to not only understand the computer side of it, but also understand how it plays in the clinical setting and how working as a radiologist will help them see where it needs to be improved specifically. Sounds like the ninth circle of hell to me and I literally had no idea what was going on for the entire conversation, but I think you can really say there's something for just about everyone in rads.

Wanting to work with my hands is one (of many) reasons I am trying to match rads this year, and I feel like that's definitely being glazed over here. Thoracentesis, paracentesis, biopsies of all kinds, joint contrast injections prior to joint imaging, lumbar punctures under fluoro, drain placements, etc are all within the territory of DR, and patients are usually pretty happy that they can breathe after paras, may have some pain relief after abscess drainage, are pretty happy when you can tell them their mammo is normal when they're a former breast cancer patient, etc. And the list of procedures and patients being satisfied after in rads goes up exponentially when you add IR into the mix. You start to get pretty happy patients when you talk about embolizing large bleeders after trauma, shooting chemo/encapsulated radiation straight into a cancer's arterial supply so the patient doesn't have to have wider side effects, etc.

 

[Matthew9Thirtyfive]

interventional psych?!?!??!?

never heard of it and neither has google.

Really? I googled “interventional psychiatry” and got like several hundred thousand results.

 

[Dave1980]

Really? I googled “interventional psychiatry” and got like several hundred thousand results.

i stand corrected. it is a thing. sounds like ECT and TMS. that being said it doesn't sound like a good specialty at all for what the OP said they like

Work with hands (doesn't have to be big open surgery, minimally invasive stuff can be pretty elegant).
Expert in my field, excellence.
Variety of pathology, patient population, presentations.
Rapidly innovative field with impactful basic, translational, clinical research opportunities.
Meaningful patient interactions by which I mean patients present with a problem and generally am able to offer solutions with good outcomes and the patients are grateful. YES
Use and interpretation of imaging
Good pay

 

[Yellow345]

I definitely know people going into rads for AI.

I've met multiple people who talked about some of their undergrad and/or med school research being in creating neural networks and a whole bunch of other AI crap I don't understand at all, and that's a reason they really like radiology. They want to be on the cutting edge of new AI technology and they see potential to not only understand the computer side of it, but also understand how it plays in the clinical setting and how working as a radiologist will help them see where it needs to be improved specifically. Sounds like the ninth circle of hell to me and I literally had no idea what was going on for the entire conversation, but I think you can really say there's something for just about everyone in rads.

Wanting to work with my hands is one (of many) reasons I am trying to match rads this year, and I feel like that's definitely being glazed over here. Thoracentesis, paracentesis, biopsies of all kinds, joint contrast injections prior to joint imaging, lumbar punctures under fluoro, drain placements, etc are all within the territory of DR, and patients are usually pretty happy that they can breathe after paras, may have some pain relief after abscess drainage, are pretty happy when you can tell them their mammo is normal when they're a former breast cancer patient, etc. And the list of procedures and patients being satisfied after in rads goes up exponentially when you add IR into the mix. You start to get pretty happy patients when you talk about embolizing large bleeders after trauma, shooting chemo/encapsulated radiation straight into a cancer's arterial supply so the patient doesn't have to have wider side effects, etc.

Ive done 3 months of rads rotations and seen 0 procedures outside of IR. The attendings I spoke to in DR also did no procedures. I wouldn’t recommend students go into diagnostic rads expecting to do procedures because you may be disappointed depending on where you end up…

 

[Matthew9Thirtyfive]

Ive done 3 months of rads rotations and seen 0 procedures outside of IR. The attendings I spoke to in DR also did no procedures. I wouldn’t recommend students go into diagnostic rads expecting to do procedures because you may be disappointed depending on where you end up…

Almost every DR I know does plenty of procedures.

 

[Dave1980]

Ive done 3 months of rads rotations and seen 0 procedures outside of IR. The attendings I spoke to in DR also did no procedures. I wouldn’t recommend students go into diagnostic rads expecting to do procedures because you may be disappointed depending on where you end up…

you have rotated at some weird places then because most body radiologists are trained to do "light IR" and most practices love when body radiologists show up and are willing to do drains and biopsies. I personally spend about 30% of my time doing procedures and I'm not IR.

I sometimes wonder where these supremely confident med students become experts on radiology and AI.

 

[Yellow345]

you have rotated at some weird places then because most body radiologists are trained to do "light IR" and most practices love when body radiologists show up and are willing to do drains and biopsies. I personally spend about 30% of my time doing procedures and I'm not IR.

I sometimes wonder where these supremely confident med students become experts on radiology and AI.

I am not an expert, only stating my limited experience.

But if you matched at the places I rotated expecting to spend a lot of your diagnostic rotations doing procedures, you would be dissapoint

 

[Dave1980]

I am not an expert, only stating my limited experience.

But if you matched at the places I rotated expecting to spend a lot of your diagnostic rotations doing procedures, you would be dissapoint

As a resident. Sure I did almost none outside of IR.

I learned them in fellowship and my first years as an Attending.

Don't extrapolate residency to the "real world"

 

[Cognovi]

I think it's fair to say that the predominance of time in DR is spent not doing procedures and the proportion of time spent doing procedures can vary widely depending on your subspecialty practice mix and institutional setup. I think it is also fair to say that a setup where there is 0 procedures outside of IR is also unusual. At my place, IR does abdominal and vascular procedures and thyroid, GI does fluoros (used to do enteric tube placement), neuro does LPs (diagnostic LP, intrathecal chemo, myelograms), MSK does joints and nerves (pain injections, arthrograms, botox), breast does breast (biopsies, needle/seed localization), nucs does skin lymphoscintigraphy injections, chest does lung biopsies, peds does peds joints and GI fluoros, emergency and cardiovascular don't do any procedures.

 

[MisterKitty]

Please take this guy with a grain of salt. I WFH 3 days a week, 8 weeks of vacation, 8 weekends a year, salaried at just under 500k this year. We work hard during the workday but we all clock in at 8 and clock out at 5

Uhh is it too late for a PGY3 in psych to switch to rads… asking for my uh friend

 

[Elite Medical Prep]

Based on the qualities you listed, I'd recommend considering ophthalmology too. Very focused and technologically advanced field with new constant influx of new innovations. Still a procedural subspecialty with some crazy cool procedures, especially in retina. There's a road into plastics too if you want to consider oculoplastics, which would see you doing a lot of botox/Mohs surgery repairs/blepharoplasties. Good pay, great lifestyle, AMAZING outcomes with very high patient satisfaction rate, etc.

 

[SurgeDO]

Neurosurgery is cool. The lifestyle isn’t as scary as people make it seem once you are an attending/senior resident. The junior resident years are torture, but you get through it. If the brain game gets too crazy for you, you can just set up shop as the local spine guy. Spine is awesome.

Despite it being a super specialized field, there’s so much variability especially if you go into PP as a general neurosurgeon. The general guys in my area regularly take out brain tumors, decompres/fuse spines, clip/coil aneurysms, and release carpal tunnels regularly throughout the week. Not to mention all the craziness that comes with trauma. You’ll always be in demand. Every hospital in the country is begging for neurosurgeons. Patients are usually very appreciative.

I love neurosurgery and would pick it again in a heartbeat.