Author Topic: Which medical specialty should I choose?  (Read 3709 times)

coconutindex

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Which medical specialty should I choose?
« on: January 29, 2017, 01:22:53 PM »
I'm a Norwegian junior doctor looking for a bit of career advice from all you sage mustachians out there. I'm sure there must be quite a few other MDs and other knowledgable folks lurking around the forum!

I finished med school in 2011, and since then I've done a mandatory internship, a few years of GP work and for the last year or so General Surgery which I enjoy a lot. Since discovering Mustachianism I've found myself thinking more purposefully about a lot of things, and next on the list is reviewing my career. I now have a young son (half a year old and growing like crazy) and I absolutely love spending time with him -  even more than I love performing cholecystectomies. And since surgery does tend to be a life-consuming specialty (even though we don't do the crazy 80hr plus-weeks of American colleagues) I'm not sure this is the best choice.. I'm a bit of a generalist and I think I could enjoy most specialties, at least the clinical ones.

It would be cool if anyone could share some thoughts or experiences about work/family life-balance for doctors. I think we who spend time on this forum share a lot of values so that's why I'm looking for advice here! Even though there are a lot of differences between the Norwegian health care and, say, the American, I think the everyday experience of doctoring is similar enough for your input to be of use.

The Happy Philosopher

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Re: Which medical specialty should I choose?
« Reply #1 on: January 29, 2017, 01:54:58 PM »
Hey Dr. Coconut :)

Work life balance for many doctors in the US is an abstract concept, although out of the box thinking can do wonders. In my mind there are three things to consider.

1. Money (low priority)
2. Lifestyle (medium high priority)
3. Love of work (essential)

I tired to prioritize 3 but accidentally ended up pretty well on 1 and 2. Bottom line is you need to be doing a specialty that you love if you want to be happy. Medicine will consume everything you have if you let it, and burnout is inevitable if you don't like what you are doing.

I ended up working half time, which I have been doing for several years now. This has been quite a fantastic compromise for me. You may find my post on part-time work interesting, as you may be able to do what you love and still have a great lifestyle. It won't work for everyone, but for others it will be nirvana.

There are articles and guides out there for choosing a specialty, but bottom line is you need to actually practice for a while to truly know what each specialty entails. Each has it's own form of tedium and frustration. Hope this helps.

http://thehappyphilosopher.com/a-physicians-guide-to-working-part-time/

crusher2015

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Re: Which medical specialty should I choose?
« Reply #2 on: January 29, 2017, 02:45:19 PM »
It's such an individual decision.

I chose GP work at 0.5-0.75 of full time. I'm just at the start of my career but my rationale is that being not quite full time will reduce the risk of burnout. I'm happy to work a little bit of a longer career as long as I enjoy it!

If you love surgery I would suggest to stick with it scale down your hours until you find your sweet spot (this may require scaling down your earnings and your spending as well).


Abe

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Re: Which medical specialty should I choose?
« Reply #3 on: January 29, 2017, 08:08:09 PM »
It's hard to project my experience in the US with yours, but I think everywhere in the world surgery is a hard specialty. Training is very demanding in time, energy, physical and emotional stress. You have to really enjoy it to get through the tough times (of which there are many). Also, your spouse has to be very supportive. If there is literally any non-surgical specialty you enjoy, consider that instead. For me there wasn't, but I also have a plan for my post-training life to not suck so it worked out in the end.

goatmom

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Re: Which medical specialty should I choose?
« Reply #4 on: January 29, 2017, 08:49:00 PM »
I am sure things in Norway are quite different than in the US but here it would be very difficult to be a part time surgeon at least in the beginning of your career.  Or take any time off.  The skill set gets lost very quickly.  In the US, surgery is a grind and you need to want to do nothing else. How about emergency room?  The hours are good and you get to do some surgery type stuff.  I would chosoe Psych all over again.  It is not for every one but you can work any hours you want and the start up costs are minimal.  You can even work from home now in the US doing a telepsych practice.  You can have a cash only practice and not even need to worry about insurance claims, etc.  I am never bored and the need for psych is just getting greater.  My plans are to just work part time probably until I am 70.  I do love it that much.  But I still have time for many other things. 

chasesfish

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Re: Which medical specialty should I choose?
« Reply #5 on: January 30, 2017, 05:00:16 AM »
I can only give you my opinion on income, I'm not a doctor but have seen plenty of financial statements.  Two of the best paying professions I've seen (without being a heart/brain/ortho surgeon) are anesthesiology and nephrology. 




Miss Prim

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Re: Which medical specialty should I choose?
« Reply #6 on: January 30, 2017, 01:50:21 PM »
How about emergency medicine.  You could probably work part-time at that and have a good work/life balance.  Not sure how well it pays, but I do have a friend who is a MD and she works as an Urgent care Dr. just so she can enjoy her life when she isn't working.

                                                Miss Prim

Mitch76

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Re: Which medical specialty should I choose?
« Reply #7 on: January 30, 2017, 01:58:34 PM »
Pathology - office hours, no annoying patients. Win win.

Freestyler

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Re: Which medical specialty should I choose?
« Reply #8 on: January 30, 2017, 04:49:33 PM »

1. Money (low priority)
2. Lifestyle (medium high priority)
3. Love of work (essential)



I second that one though I also ended up (not unpurposedfully) mostly getting the full pack. Being a mustachian physician, even in most of Europe (where I work), you should be able to enjoy some financial ease and, eventually, reach FI (not so easily really ER). The field is demanding though and you should expect all sort of bumps in the way. It can get very tough if you don't like the chosen specialization. Even in a given specialization the actual specific practice (field, setting, etc) may make all the difference and you'll have more much needed drive to pursue the ideal circumstances if you are generally upbeat and motivated by your specialization to start with.

Having said all that General Surgery looks physically tough to me, specially when growing older. But that may just be me that has a low tolerance for lengthy standing up periods. So much cooler to perform surgery while seated :-).

Due to a number of reasons it looks like medicin may be more apt for a SWAMI approach rather than full fledged mustachianism. So maybe choose something that you see yourself motivated to do longer term. If you manage to additionally get the quality of life and the money, more power to you.

On another note Norway must be a great country for a Norwegian physician to practice, so in some regards you may be at an advantage compared to your peers in other countries.
« Last Edit: February 04, 2017, 02:18:46 PM by Freestyler »

goatmom

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Re: Which medical specialty should I choose?
« Reply #9 on: January 30, 2017, 08:01:31 PM »
Pathology - office hours, no annoying patients. Win win.

Most pathologists I know are not too happy right now.  Reimbursements have been cut for the stuff they do so most have ended up as employees for hospitals.  Hospitals are using PhDs to manage labs.  In the U.S., pathologists are having a hard time finding jobs unless they have done 1 or 2 fellowships.  Very bad job market in the U.S. 

mwulff

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Re: Which medical specialty should I choose?
« Reply #10 on: January 31, 2017, 12:41:50 AM »
My wife is a doctor here in Denmark. She chose the GP route since it balances working hours with income. Also because she gets to see a little bit of everything.

GP's also have some options for going part-time. Which is nice.

Mitch76

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Re: Which medical specialty should I choose?
« Reply #11 on: January 31, 2017, 02:18:44 AM »
Pathology - office hours, no annoying patients. Win win.

Most pathologists I know are not too happy right now.  Reimbursements have been cut for the stuff they do so most have ended up as employees for hospitals.  Hospitals are using PhDs to manage labs.  In the U.S., pathologists are having a hard time finding jobs unless they have done 1 or 2 fellowships.  Very bad job market in the U.S.

It's a lot better in the UK, my department is acutely short of consultants, especially in haem and micro. One of our microbiology consultants quit last year, and we were so short staffed they immeadiately hired him back as a long term locum - resulting in his salary raising by over 100% for doing a similar job but with less departmental responsibilities.

Linea_Norway

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Re: Which medical specialty should I choose?
« Reply #12 on: January 31, 2017, 02:26:48 AM »
Off-topic, but please join us on the Norway-thread.

http://forum.mrmoneymustache.com/meetups-and-social-events/any-mustachians-living-in-norway/

Maybe you should look into whether payment is different in different parts of the country. Out in the districts they have trouble keeping general practitioners at work. Perhaps this also applies to hospital medics. Maybe you can get extra financial support for working in the district?
« Last Edit: January 31, 2017, 02:35:54 AM by Linda_Norway »

coconutindex

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Re: Which medical specialty should I choose?
« Reply #13 on: February 04, 2017, 12:40:15 PM »
Lots of great advice and things to contemplate from all of you, thanks! Frugaldoc, your list of priorities is similar to mine, am looking forwards to reading the linked-to article.

Part time work is a bit of a challenge for Norwegian doctors. It would definitily be possible for a GP or a psychiatrist, but in any kind of hospitalist position not so much. Emergency room work seems great in many regards but we don't actually have that as a separate specialty, emergency cases here are seen by the relevant specialists alongside their other duties. In terms of pay differences they aren't that great here compared to the US. GPs actually get paid really well (to facilitate recruitment), the same goes for psychiatrists. For hospital doctors it's pretty much the same for most specialties with a few exceptions. If you work in the private sector things are different but not very many do.

Linda, your point about geographical differences is actually a good one. If one wanted to retire early I think the best way to go would work for some years as a District GP in Northern Norway - the pay is good, there are tax benefits - and not a whole lot to spend the income on!

I suppose I'll keep on in my present position for a bit longer, I don't feel as if I've testet it quite long enough. But it is a choice that warrants careful consideration! I think that's the great thing about having found this little online community; it's very inspirational learning from people who have made conscious choices about their lifestyle and career, even if my own choices would turn out to be different..

MajorTom

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Re: Which medical specialty should I choose?
« Reply #14 on: February 04, 2017, 03:04:21 PM »

1. Money (low priority)
2. Lifestyle (medium high priority)
3. Love of work (essential)


I would slightly change point 3 to LIKE of work. Maybe it's just me, but I always found talk of "doing what you love", etc, to engender a sense of pressure in that if you aren't loving what you're doing then you're failing, made the wrong choice, etc. personally, I can't imagine loving anything full time, especially in medicine, whereas just liking a job makes me feel more relaxed :-).

Choosing a speciality will obviously be pretty personal, but I definitely recommend considering all 3 of frugaldoc's considerations. The extra thing I would add, which may be obvious, is the nature of the job itself, which can be difficult to know when you're working as a resident- ie. What does the day to day nature of working as a consulate the look like for that speciality, and are there options within the speciality ( eg diagnostic versus interventional radiology).

Some advice I remember was make sure you don't mind the common stuff in the speciality you're considering. Eg. Don't become an endocrinologist because you once presented a case of Hashimoto's thyroiditis and thought it was really interesting, when you find diabetes management tedious...

There's also a lot of pressure in medicine to devote yourself to your job, often to an unhealthy degree (many of our eminent peers spoken about with respect and reverence also have terrible personal/family lives...)
Don't fall into the trap of doing what others think you should to and consider outside the box options.

I chose psychiatry and am happy with my decision- reasonably interesting job but, most importantly for me, great lifestyle and easy to tweak to your own preferences (at least it is in Australia- public versus private, full time or part time and associated income level).

My plan when I finish in a few months is to initially do locum work only, which is well paid, has a large demand, and provides lots of travel around the country (generally with flights, accommodation, car, etc). I don't have kids so it's easy for me and my partner to do. Also, locum work has the added benefit that you only need to focus on the clinical work (which I like) and not the business/policy/political aspects, which I loathe.
I'm aiming for working about 9-10 months of the year for a few years to finish paying off our house and to get a good start on our investment stash, then will aim to reduce to working about 6 months of the year until FIRE, then just whatever I feel like.
If at any point I get sick of the locum lifestyle then I will probably just go into private practice 4 days a week until FIRE, and just do some occasional locum work for some extra money and exposure to public psychiatry.

Good luck!
« Last Edit: February 04, 2017, 03:06:28 PM by MajorTom »

The Happy Philosopher

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Re: Which medical specialty should I choose?
« Reply #15 on: February 04, 2017, 04:03:06 PM »

1. Money (low priority)
2. Lifestyle (medium high priority)
3. Love of work (essential)


I would slightly change point 3 to LIKE of work. Maybe it's just me, but I always found talk of "doing what you love", etc, to engender a sense of pressure in that if you aren't loving what you're doing then you're failing, made the wrong choice, etc. personally, I can't imagine loving anything full time, especially in medicine, whereas just liking a job makes me feel more relaxed :-).

Choosing a speciality will obviously be pretty personal, but I definitely recommend considering all 3 of frugaldoc's considerations. The extra thing I would add, which may be obvious, is the nature of the job itself, which can be difficult to know when you're working as a resident- ie. What does the day to day nature of working as a consulate the look like for that speciality, and are there options within the speciality ( eg diagnostic versus interventional radiology).

Some advice I remember was make sure you don't mind the common stuff in the speciality you're considering. Eg. Don't become an endocrinologist because you once presented a case of Hashimoto's thyroiditis and thought it was really interesting, when you find diabetes management tedious...

There's also a lot of pressure in medicine to devote yourself to your job, often to an unhealthy degree (many of our eminent peers spoken about with respect and reverence also have terrible personal/family lives...)
Don't fall into the trap of doing what others think you should to and consider outside the box options.

I chose psychiatry and am happy with my decision- reasonably interesting job but, most importantly for me, great lifestyle and easy to tweak to your own preferences (at least it is in Australia- public versus private, full time or part time and associated income level).

My plan when I finish in a few months is to initially do locum work only, which is well paid, has a large demand, and provides lots of travel around the country (generally with flights, accommodation, car, etc). I don't have kids so it's easy for me and my partner to do. Also, locum work has the added benefit that you only need to focus on the clinical work (which I like) and not the business/policy/political aspects, which I loathe.
I'm aiming for working about 9-10 months of the year for a few years to finish paying off our house and to get a good start on our investment stash, then will aim to reduce to working about 6 months of the year until FIRE, then just whatever I feel like.
If at any point I get sick of the locum lifestyle then I will probably just go into private practice 4 days a week until FIRE, and just do some occasional locum work for some extra money and exposure to public psychiatry.

Good luck!

Those are great observations MajorTom. You have to be able to tolerate the tedium of what you do to really thrive in any medical specialty. I guess when I used the world love I was not referring to loving everything about the job, but there should be something. For instance, a surgeon really needs to love doing surgery to offset all the painful things that come with the career. I thought about psych.

LAGuy

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Re: Which medical specialty should I choose?
« Reply #16 on: February 04, 2017, 04:10:12 PM »
Pathology - office hours, no annoying patients. Win win.

Most pathologists I know are not too happy right now.  Reimbursements have been cut for the stuff they do so most have ended up as employees for hospitals.  Hospitals are using PhDs to manage labs.  In the U.S., pathologists are having a hard time finding jobs unless they have done 1 or 2 fellowships.  Very bad job market in the U.S.

Wanted to chime in here. I work in hospital labs (I'm what's called a Clinical Lab Scientist -CLS). As such, my boss (or my bosses boss) is a pathologist. I can't comment on the job market, but I always thought it looked like a pretty good gig. Normal hours, except for the most senior guys who basically work a half day then go play golf. Most people probably imagine a pathologist is cutting into dead bodies, but most of the job entails running the lab (and in bigger hospitals that's a serious endeavour), looking at biopsies, or looking at bone marrow slides. I've never seen a PhD only running a lab, though I have seen several MD/PhD's. The pay cuts mentioned here happened a long time ago (a law passed by Congress in 1988) and was frankly pretty warranted. Before that, pathologists got a cut of every single test that went through a lab. Every CBC, every urine examination, every basic metabolic panel. They were bar none the highest paid MD specialty. You can tell some of the old boys are still bitter about it - in the smaller hospitals they basically refuse to have anything to do with running the lab...they've washed their hands of it and left it to us (though their signature still goes out on the results).

coconutindex

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Re: Which medical specialty should I choose?
« Reply #17 on: May 04, 2018, 10:22:55 AM »
I got a lot of great advice when I posted this! Thought I'd write a followup as I've finally decided to change my specialty.. I'm leaving surgery and will start a residency in dermatology in a few months! A bit of a pay cut but the hours will be so much more family friendly, and also enables us to move to a town closer to family. So yay!