Guest drpro Posted July 14, 2005 Report Share Posted July 14, 2005 could someone please compare the amount a specialty is paid and the amount of hours they work a week. and which specialties in general tend to have more flexible lifestyles Link to comment Share on other sites More sharing options...
Guest Ian Wong Posted July 15, 2005 Report Share Posted July 15, 2005 Most specialties can be tailored to improve the lifestyle if you are willing to make adjustments in your practice (ie. by limiting it, joining a large group to share call, by taking only locum assignments where you don't have to run the office, etc). Specialties like Family Medicine therefore really vary depending on how you set up your practice. You could have really sweet hours if all you did was work walk-in clinics, or otherwise limited your practice so you never delivered babies or set foot in the hospital. On the other hand, if you offer a full set of medical services, and you happen to practice in a rural or underserved area, you are going to be crazy-busy. The below is not an exhaustive list by any means. Lifestyle friendly specialties include Pathology, Psychiatry, Dermatology, Radiology, Anesthesiology, Physiatry/PM&R, Emergency Medicine, Radiation Oncology, Ophthalmology, several Internal Medicine subspecialties (ie. Endocrinology, Rheumatology, Allergy and Immunology, etc). Certain surgical subspecialties can also be tailored to have a pretty decent lifestyle, such as Urology, ENT, or Plastic Surgery. Specialties that tend to be on the high end of compensation usually have factors that influence this. These specialties include Anesthesiology, Radiology, Derm, Ophthalmology, Urology, ENT, Plastic Surgery, some Internal Medicine subspecialties (notably Cardiology and Gastroenterology), and Orthopedic Surgery. Some of these specialties may have no office requirement, which means that you work primarily in the hospital, or another location where someone else bears the costs of your workspace (so you take home more of your own money). Other specialties are highly procedural (you generally make more money doing procedures on people than you do seeing and talking to those people). Other specialties let you opt out of the public health-care system for services/procedures that aren't medically necessary, and so you can charge your patients whatever amount of money you want. Bottom line, lifestyle and money should definitely be somewhere in your mind when choosing a specialty. It shouldn't be the only thing, however. Personal enjoyment of what you do, and looking forward to coming to work each morning is going to be paramount. Ian Link to comment Share on other sites More sharing options...
Guest Jag Posted July 15, 2005 Report Share Posted July 15, 2005 I always thought anesthesiology wasn't a lifestyle friendly specialty because you had to be on call a lot for emergency surgery? Link to comment Share on other sites More sharing options...
Guest physiology Posted July 15, 2005 Report Share Posted July 15, 2005 Hey Jag, It depends. If you're an anesthesiologist in a smaller community, then you would be on call more. If you work in a large urban centre, again, you'd be on call, but not as frequently. However, you also have to factor in your experience. Anesthesiologists fresh out of residency get the worst call schedules because they have lower priority and less experience, as with other jobs. Also, it depends which fellowship you pursue. Certain ones such as a pain fellowship, would offer a better lifestyle. I shadowed the head of anesthesiology at UBC, and he works 7 am to 5-6 pm everyday - these are considered very good hours in medicine, but it took him 15+ years to get this type of schedule. Link to comment Share on other sites More sharing options...
Guest flainechiu Posted July 15, 2005 Report Share Posted July 15, 2005 Hi, Can anyone comment on the lifestyle of a cardiologist? I know for all fields in medicine you have to pay your dues at the beginning, but I get the impression that after a while the hours in cardiology are reasonable, although not as great as some other specialties. Also, how often might a cardiologist be on call? Same question about neurology and radiation oncology if anybody knows. Thanks! Link to comment Share on other sites More sharing options...
Guest opiedog Posted July 16, 2005 Report Share Posted July 16, 2005 The amount you are on call in any specialty is highly dependant on the supports that you have. If there are few others in your field, you have less options (people) to play tag with. I lived in one town (U.S.) where the cardiologist was the ONLY one, and he was on call 24/7. I can tell you that he was called virtually every night for some issue that arose in ICU or emerg. I have no idea how he ever managed to stay sane, but he remained a very nice and approachable person during the day! Link to comment Share on other sites More sharing options...
Guest drpro Posted July 16, 2005 Report Share Posted July 16, 2005 great post ian helped me out a lot... just a few follow up questions which specialties minimize overhead costs? I'd assume, the specialties with the least amount of overhead costs would work in a hospital, but i wouldnt want to be on a salary, where there would be a ceiling on ones earnings, is it possible to not be on salary and work at a hospital? would you mind commenting on the lifestyle and the hours one would work as a thoracic or cardiac surgeon also are most dermatologists in private practise? i remember seeing a link here with a thread describing all of the specialties, can anyone provide me with that link? Link to comment Share on other sites More sharing options...
Guest drpro Posted July 16, 2005 Report Share Posted July 16, 2005 sorry for not including this in the last post it is kind of off topic.. since i still am a premed i dont know certain things what exactly is a fellowship? Link to comment Share on other sites More sharing options...
Guest moxiekat Posted July 16, 2005 Report Share Posted July 16, 2005 Also... are there any fields in which you can work part-time? I.e. only 3 or 4 shifts a week? I know emergency medicine is one, but I am not sure about any of the others... Link to comment Share on other sites More sharing options...
Guest marbledust Posted July 16, 2005 Report Share Posted July 16, 2005 Also... are there any fields in which you can work part-time? I.e. only 3 or 4 shifts a week? I know emergency medicine is one, but I am not sure about any of the others... Many specialties can be tailored to suit one's individual needs. Some like family medicine and psychiatry can pretty much be as flexible as you want in terms of working part-time. If you have a private practice, you can usually work what you want. Of course, working in a larger centre, as oppossed to a rural area, will likely allow more considerably more flexibility. Other factors include how much money you want/need to make, the needs of other physicians in your practice, etc. I know of several family docs and a few psychiatrists who only practice part-time. All seem fairly content with their arrangments. Link to comment Share on other sites More sharing options...
Guest hash Posted July 16, 2005 Report Share Posted July 16, 2005 I believe a fellowship is another year or two of training that an individual does after their residency. Its usually some niche area. eg: An orthopedic surgeon can do a fellowship in spinal surgey or knee surgery, etc... Link to comment Share on other sites More sharing options...
Guest endingsoon Posted July 16, 2005 Report Share Posted July 16, 2005 cardiology is horribe lifestyle...lots of sick patients (ie - ccu) and lots of consults from the emerg every night. A community cardiologist I worked with typically did call 5 times per month and covered CCU (ie - duirng the day) one week in 6. Link to comment Share on other sites More sharing options...
Guest Ian Wong Posted July 16, 2005 Report Share Posted July 16, 2005 which specialties minimize overhead costs?Hospital-based specialties, for the most part. This includes Anesthesiology, Radiology, Pathology, and Emergency Medicine. Note that these specialties do have other options. You could do a pain fellowship in Anesthesiology and see patients in your own clinic, or work for oral surgeons/private surgical centers outside of the hospital. If you have a stake in those operations, you might share in the overhead burden. Radiology can get outside the system via private imaging centers owned by radiologists. There's tons of overhead in maintaining radiologic equipment, particularly high-end stuff like MRI's. Pathologists can open up their own private labs (there's a huge private lab conglomerate in BC called MDS Metro which was started by a pathologist). Emerg Med if you got into it through a Family Medicine background means that you could always go back into FM. Folks who got into EM through the full 5 year EM residency quite often have academic or admin interests.I'd assume, the specialties with the least amount of overhead costs would work in a hospital, but i wouldnt want to be on a salary, where there would be a ceiling on ones earnings, is it possible to not be on salary and work at a hospital?You do NOT have to be on a salary at the hospital. It is very possible to form a private group of physicians, and then contract your services out to the hospital (this is commonplace). The way you negotiate your reimbursement then dictates whether you are salaried vs fee-for-service.would you mind commenting on the lifestyle and the hours one would work as a thoracic or cardiac surgeonHorrible. Some of the worst hours in medicine. Many of your patients are incredibly sick (either pre-operatively or post-operatively). By definition, that means tons of hours in the hospital.also are most dermatologists in private practise?Yes. A large part of Derm income is from cosmetic procedures. The other large portion is from procedures like skin biopsies. These things generally don't need to occur in a hospital setting and usually can be done in-office. Ian Link to comment Share on other sites More sharing options...
Guest UWOMED2005 Posted July 16, 2005 Report Share Posted July 16, 2005 I think the "hidden gem" in terms of lifestyle and $$ is PM&R, or physiatry. My roommate from UWO matched to that. Many medical students don't know what it is. . . so it's often not horribly competitive to get into. . . relative to derm, plastics, ophtho, etc. In terms of raw OHIP/AHIP/QHIP/BCHIP/etc billings, PM&R looks like family. Thing is, that's only a fraction of the cases the PM&R docs. Many of their cases are work-related, meaning they bill to WSIB (in Ontario) rather than OHIP. They can often bill as much to WSIB as they do to OHIP. . . effectively doubling their actual salary relative to what you read on "official" salary sites. ON TOP OF THAT. . . many PM&R guys do "independent medical assessments". . . entirely private in terms of renumeration, for insurance companies or lawyers representing patients who are involved in disability claims. At least one London PM&R doc is known to have made more than a million, and others often make in the high hundred thousands. AS well - you set your own hours (one clinic I participated in was 10am to 2pm) and there are few 3am emergencies in the field. You just have to be able to stand the work. I'll let you figure out what I mean by that on your own. Link to comment Share on other sites More sharing options...
Guest drpro Posted July 16, 2005 Report Share Posted July 16, 2005 You just have to be able to stand the work. I'll let you figure out what I mean by that on your own. anyone know what the above poster is eluding to in this post? also ian, you mentioned "tons" for hours in the hospital for a thoracic or cardiac surgeon, by "tons" are we talking maybe 12hrs/day - so maybe 60-70/week or near or even over 100hrs/week(resident type hours) Link to comment Share on other sites More sharing options...
Guest endingsoon Posted July 16, 2005 Report Share Posted July 16, 2005 by handle the type of work he means that the job is not everyones cup of tea. Lots of MSK complaints, back pain, people wanting not to work, etc. Really not something I personally could stand. Link to comment Share on other sites More sharing options...
Guest physiology Posted July 16, 2005 Report Share Posted July 16, 2005 Other "hidden" specialties include 1) medical genetics - I'm not sure of the call schedule (McMaster girl would know). But again it can be difficult work though, having to diagnose children with difficult and rare diseases, having their parents cry and immediately wonder if their child is going to die, etc. It also lends itself well to academic and research work, for those who are interested in having a diverse career consisting of clinical work, research, and teaching. 2) occupational medicine - this one is interesting - I think U of T and U of A offer residencies in this; but according to the stats, very few people match to this program 3) Medical biochemistry - McGill's stream is somewhat different than that of rest of Canada. Generally, people do this as a fellowship during their pathology residency, but McGill's program allows you to see patients. I know a physician who does this. However, he finished 20 some odd years ago, so perhaps it's changed. Again - there's no on call. Once in a blue moon you may get a phone call here and there, from a physician who doesn't know which test to order. Link to comment Share on other sites More sharing options...
Guest marbledust Posted July 16, 2005 Report Share Posted July 16, 2005 ON TOP OF THAT. . . many PM&R guys do "independent medical assessments". . . entirely private in terms of renumeration, for insurance companies or lawyers representing patients who are involved in disability claims. There is also a lot of opportunity for psychiatrists to engage in "independent medical assessment" work. I know of a couple in Calgary who have basically closed up their private practices and do this almost exclusively. It allows for a great deal of flexibilty...in addition to lotsa money. Link to comment Share on other sites More sharing options...
Guest UWOMED2005 Posted July 17, 2005 Report Share Posted July 17, 2005 What endingsoon says is pretty much what I was getting at. . . I don't mean to knock PM&R, but many med students do find they don't like the actual clinics in PM&R when they do electives - but there's no knowing until you try! Hmm. . . marbledust - I actually hadn't heard that before. Link to comment Share on other sites More sharing options...
Guest marbledust Posted July 17, 2005 Report Share Posted July 17, 2005 Hmm. . . marbledust - I actually hadn't heard that before. It's not something I thought about either. But I chatted with a psychiatrist a few years ago and she told me she was shutting down her private practice because the opportunity to do independent medical assessments for insurance companies and workman's compensation (and the often accompanying testifying in court) allowed her the most flexibilty to spend time with her young family. Last year, another psychiatrist joined her and they are mega busy. Or, as busy as they choose to be, is more like it. It's not something I know a whole lot about. But from what I understand, it would be along the same lines as what a PMR doc would do--except from a psychiatric viewpoint. IE: is the patient capable of working, willing to work, what effect has the injury/psychiatric condition has had on them, etc. As with PMR, you would probably be dealing with a somewhat difficult group of patients at least some of the time... Forensic psychiatry also gives one considerable opportunities to do court and independent assessment work with patients who have committed crimes. If you are in demand, you can bill very, very nicely. Forensics is typically a one year fellowship on top of a psych residency. There is a well developed forensics program at the PLC in Calgary. Link to comment Share on other sites More sharing options...
Guest satsumargirl Posted July 17, 2005 Report Share Posted July 17, 2005 On the physiatry thing. My comments will be from the perspective of an SLP who's worked in in-patient rehab. I think in order to be happy in rehab you have to be someone who is comfortable with things not being very black & white. e.g. No two strokes are the same physically or psychosocially. You cannot really predict how someone will recover or how each person will adjust. You have to be a big team player and I think really understand the roles of OT, PT and SLP etc. A physiatrist isnt going to "fix" someone on their own. When I worked on stroke rehab the physiatrists basically managed pain, mood (obvioulsy lots of depression after a stroke maybe agressive behaviours as well), bed sores and followed progress in various therapies (via rounds...never did they come to see a therapy session) in order to decide when it was appropriate to be discharged and where they would be discharged to (home, LTC etc.). Generally by the time the pt gets to rehab they are physically stable but sometimes they are discharged from acute too early. So there can be some new things that pop up but in that case, the pt gets sent back to acute anyway. Rehab is slow, sometimes tedious, lots of work, you must keep the pt and family motivated even when you don't feel so motivated yourself. You work really hard for sometimes small gains. You have to be o.k. with this. There's no magic pill, it's not like stitching up a cut or cutting out a tumour. To some extent the physiatrist probably feels this a little less than the therapists (since we are the ones doing the therapies for hours in a day). But still, it would be rare if your patients leave you "cured". (unlike say ophthalmology where a person comes in and can't see 'cause they have a cataract and then you remove it and it's all done). If you work on ABI you have to be comfortable with all the behaviours that can go along with it. I think physiatry is intersting. You can get lost of neuro if you like that but perhaps you get more of a chance to deal with the social aspects of illness as well. And obviously you have to like that. I like that it has an emphasis on function. And there will be a great need for them with our aging population. If you are a good personality match could be a fulfilling career. As for the billing to insurance companies etc. It is alot of paperwork! Justifying x, y, z, predicting time for gains, exlaining why x, y, z is taking longer and more $$$ for Tx needed etc. Link to comment Share on other sites More sharing options...
Guest GradApp Posted January 8, 2006 Report Share Posted January 8, 2006 Hi everyone, I was wondering what the view of neurosurg is, especially anyone who has some clerkship or residency experience...is it still considered the worst of the worst?! Is it true that fellows can no longer work in the US, and there are no positions in Canada for the next 20 years? - It's a tremendously appealing practice, nad having spent some time shadowing a neurosurgeon I'm really thinking about it - but these concerns are diminishing my enthusiasm! Anyone with any insight, I'd really appreciate hearing from you... Thanks! Link to comment Share on other sites More sharing options...
Guest Kirsteen Posted January 8, 2006 Report Share Posted January 8, 2006 Hi there, Regarding one of your questions, i.e., US neurosurgery positions for Canadians, I believe it was only recently that the welcome mat was pulled for Canadian neurosurgeons, i.e., within the past few years. I haven't heard of any news re: re-opening the door to Canadian neurosurgeons again. Cheers, Kirsteen Link to comment Share on other sites More sharing options...
Guest satsumargirl Posted January 8, 2006 Report Share Posted January 8, 2006 www.ices.on.ca/webpage.cfm?site_id=1&org_id=32&morg_id=0&gsec_id=3001&item_id=3001&category_id=48 Hi GradApp I posted this in the surgical subspecialties forum a little while ago...perhaps it can answer some of your questions. It is Ontario specific and discuses supply/demand, work conditions etc of neurosurgeons (brain and spine) and interventional neuroradiologists (I think one other related discipline...but I can`t think of it right now). Link to comment Share on other sites More sharing options...
Guest GradApp Posted January 8, 2006 Report Share Posted January 8, 2006 Thanks very much, especially for the publication - it really covers a great deal of ground! Much appreciated, and if there is anyone out there who has personally done a neurosurg elective (or a radiology elective with some interventional neuro procedures!), I would love to hear from you - you can message me directly if preferable! Thanks once again. Link to comment Share on other sites More sharing options...
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