Help with choosing specialty

[deleted1190957]

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[DO2015CA]

ENT. Procedures will be the hardest to lose their job. Large part of training is facial plastics for aesthetics. Sure you can have long call shifts but in a big group it can be few and far between (except maybe dealing with your own post op complications) @operaman

 

[deleted1190957]

ENT. Procedures will be the hardest to lose their job. Large part of training is facial plastics for aesthetics. Sure you can have long call shifts but in a big group it can be few and far between (except maybe dealing with your own post op complications) @operaman

Thank you very much for your message. It is interesting you mention ENT as that is what the bulk of my research projects is in! My concern with ENT however is the residency. I have read that you are required to work an average of 80 hours per week and still do research and study on top of this and take call all night. I have never been a resident but the idea to me of having insomnia already with this kind of schedule I wonder if I would even survive the residency or end up harming a patient due to the sleep deprivation. I have pulled all nighters several times in medical school just to get stuff done but I can't imagine pulling two back to back and have that be constantly repeating for 5 or 6 years.

 

[Captain_Falcon]

Derm

 

[DO2015CA]

Thank you very much for your message. It is interesting you mention ENT as that is what the bulk of my research projects is in! My concern with ENT however is the residency. I have read that you are required to work an average of 80 hours per week and still do research and study on top of this and take call all night. I have never been a resident but the idea to me of having insomnia already with this kind of schedule I wonder if I would even survive the residency or end up harming a patient due to the sleep deprivation. I have pulled all nighters several times in medical school just to get stuff done but I can't imagine pulling two back to back and have that be constantly repeating for 5 or 6 years.

I have trouble initiating sleep as well. On my 24s, there were nights I didn’t sleep hardly any. One of my specialty requirements was a constant sleep schedule like you’re. You do get through it though.

Another to think about is PMR. I don’t remember the residents having crazy call outside of their intern year rotating on other services like ICU, IM, etc. They do procedures especially if you do an interventional pain fellowship.

 

[operaman]

ENT is definitely one worth considering.

Your concerns about the residency are well founded but coming from a top school and assuming you have a stellar app, you may have some choices than can mitigate many of those issues.

Basically, you're going to want to target larger programs that utilize a night float system, and you will want to de-prioritize programs with "home" call. In the middle are programs with in-house call. Night float seems to be a preference these days and basically you do all your overnight calls as a junior resident in a couple large chunks with no other clinical responsibilites during that time. So yes you'll be up all night, but you'll sleep during the days and mainly only really struggle with the transition between that and regular rotations. "Home" call is where you're still spending most of your night in the hospital but you don't get a post-call day and it's actually not an ACGME violation for you to essentially work 30-36 hours straight sometimes. The call schedule and style really dictates your life - the rest is pretty scheduled.

Your scheduled time will vary widely between rotations. For ENT, the head and neck cancer services tend to suck all the resources anyone is willing to give, has longer cases, sicker patients, etc. My H&N days were usually 6am to 5-6pm most days, with some days going to 9 or 10 if there was an add on or longer case (or slower attending). For us, weekend rounds were done by the call team so it was basically 60-70 hours per week most of the time. Weekend call would bump that up, but our call was fairly infrequent. Non-H&N rotations could be much more chill - rounds at 6:30 or later if there were inpatients at all, and clinics/OR finishing earlier around 3/4pm. Could usually get out the door by 5pm on some of those days, sometimes earlier if nobody to pm round on.

ENT definitely hits many of the things you want, especially if you're intersted in facial plastics. You can go cash-pay cosmetic FP and make big bucks that way, or can do facial plastics/recon and make bank doing big free flap cases. Just depends what sort of aesthetics really get you going!

Job security is as good as it gets - insane demand and very few new grads coming out relative to demand. Income potential is excellent with the national median hovering just under 500k right now. At current market rates, income potential from purely personal clinical volume probably caps out around $1.4-1.5m. To get higher than that you're usually looking at folks with thriving cash-pay practices with lots of ancillary services and things like owning surgery centers, imaging, hearing aid vendor, etc. Plenty of docs make more than we do, but I think we hit a sweet spot in terms of money:lifestyle ratio for surgeons.

 

[smq123]

Hello everyone,

I am a medical student that is lost on which specialty to focus my efforts in and am seeking advice/thoughts. For context, I attend a top 10 MD school in the United States.

Frankly speaking, I think all of medicine is very interesting and I could see myself doing various things. I have, however, learned of a few things about myself that might help narrow down a field:

1) I thrive with a consistent schedule and a solid 8 hours of sleep every night. I do not mind at all if my career consumes my life and I love spending all day at the clinic/hospital, but I have suffered from insomnia for the longest time and cannot cope very well with inconsistent sleep or a constantly changing schedule.

2) I very much enjoy doing procedures

3) Job security is very important. Of course this applies to everyone, however I have several people dependent on my income.

4) I do believe aesthetics matter. I feel this is necessary to say as it seems the general consensus around my colleagues is that aesthetics don't matter/ are a waste of resources. I was an art major before medical school and also have suffered from many self esteem issues and bullying due to my looks. That being said, I do not want to only do aesthetics.

5) I do not want to be an employee after finishing training.

Everything else I really do not have a strong opinion on and could go one way or the other.

Thank you for reading my post and I look forward to reading your thoughts.

Do you have the grades for derm?

 

[deleted1190957]

ENT is definitely one worth considering.

Your concerns about the residency are well founded but coming from a top school and assuming you have a stellar app, you may have some choices than can mitigate many of those issues.

Basically, you're going to want to target larger programs that utilize a night float system, and you will want to de-prioritize programs with "home" call. In the middle are programs with in-house call. Night float seems to be a preference these days and basically you do all your overnight calls as a junior resident in a couple large chunks with no other clinical responsibilites during that time. So yes you'll be up all night, but you'll sleep during the days and mainly only really struggle with the transition between that and regular rotations. "Home" call is where you're still spending most of your night in the hospital but you don't get a post-call day and it's actually not an ACGME violation for you to essentially work 30-36 hours straight sometimes. The call schedule and style really dictates your life - the rest is pretty scheduled.

Your scheduled time will vary widely between rotations. For ENT, the head and neck cancer services tend to suck all the resources anyone is willing to give, has longer cases, sicker patients, etc. My H&N days were usually 6am to 5-6pm most days, with some days going to 9 or 10 if there was an add on or longer case (or slower attending). For us, weekend rounds were done by the call team so it was basically 60-70 hours per week most of the time. Weekend call would bump that up, but our call was fairly infrequent. Non-H&N rotations could be much more chill - rounds at 6:30 or later if there were inpatients at all, and clinics/OR finishing earlier around 3/4pm. Could usually get out the door by 5pm on some of those days, sometimes earlier if nobody to pm round on.

ENT definitely hits many of the things you want, especially if you're intersted in facial plastics. You can go cash-pay cosmetic FP and make big bucks that way, or can do facial plastics/recon and make bank doing big free flap cases. Just depends what sort of aesthetics really get you going!

Job security is as good as it gets - insane demand and very few new grads coming out relative to demand. Income potential is excellent with the national median hovering just under 500k right now. At current market rates, income potential from purely personal clinical volume probably caps out around $1.4-1.5m. To get higher than that you're usually looking at folks with thriving cash-pay practices with lots of ancillary services and things like owning surgery centers, imaging, hearing aid vendor, etc. Plenty of docs make more than we do, but I think we hit a sweet spot in terms of money:lifestyle ratio for surgeons.

Thank you for your very detailed comment.

May I ask why you recommend ENT -> Facial plastics and not just going straight to integrated plastic surgery?

Do you have the grades for derm?

Yes I do however I am lacking in research in the field. I don't mind taking a research year however so this is not a problem that I can't fix.

 

[DO2015CA]

Thank you for your very detailed comment.

May I ask why you recommend ENT -> Facial plastics and not just going straight to integrated plastic surgery?


Yes I do however I am lacking in research in the field. I don't mind taking a research year however so this is not a problem that I can't fix.

From my experience, ENT is better at facial plastics and you are the expert on nose reconstruction which is a big aesthetic piece. Integrated plastics excel at flaps. Boobs & butts

 

[Dral]

Could think about Ophtho and consider oculoplastics.

 

[deleted1190957]

Could think about Ophtho and consider oculoplastics.

This was also something I was considering.

How would one go about deciding on ENT vs Ophtho vs Derm? All 3 seem like wonderful fields and all 3 are also super competitive so it's not like I can dual apply and see what I match. Additionally, my school has home programs for all 3. I am in a bit of a situation where I am paralyzed by choice.

 

[Dral]

Try your best to get some research in that is either generic or can be applied to all three somehow.

Get rotations asap in all three and see what you like.

I was path vs derm. I did both rotations asap at beginning of 4th year. Derm clicked and I decided to go with it.

 

[operaman]

Thank you for your very detailed comment.

May I ask why you recommend ENT -> Facial plastics and not just going straight to integrated plastic surgery?


Yes I do however I am lacking in research in the field. I don't mind taking a research year however so this is not a problem that I can't fix.

Great question. Integrated plastics is also another great choice and probably a better one if your ultimate goal is recon and aesthetics for the whole body.

ENT definitely gets better facial plastics training though. Even as a resident, I logged more rhinoplasties than most plastics fellows, not to mention getting quite a bit of exposure to all the other facial aesthetic procedures. Had I wanted a career in FP, I could have done a lot more especially as a chief.

We also spend a lot more time operating in the head and neck so we get a lot more comfortable with the anatomy than anyone else. We’re always the ones other surgeons call for help when they get lost in the head and neck and skull base. So if your goals are mostly toward facial aesthetics, ENT would be a great option and you would be more comfortable with some of the bigger/riskier procedures than most.

You also have to consider the rest of the field as a whole, both in terms of what you’d do in training and what you’d ultimately do in practice. Even if your goal is to own your own aesthetic surgery practice, building one takes time and most docs will either do locums or take extra call to make money while their practice is building for the first few years. Depending on the market and your marketability, this period can vary widely. But probably a safe bet you will be practicing some of the bread and butter of your specialty both in training and after for some period of time.