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Dongzhuo

Guide to choosing a residency

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Throughout med school and residency, I pondered long and hard regarding what is the ideal specialty. There are just so many out there that I may be bewildering to choose. Should you be a family doctor or a psychiatrist? Or a general surgeon or a dermatologist? I think I have narrowed it down to four key attributes that defines a specialty. Let's call it Dongzhuo's HEMS of a specialty.

 

1. Hotness factor

This is how good a specialty sounds to laymen on the street. For example, saying you're a neurosurgeon has lots of hotness factor whereas saying you're a pathologist probably has a low score here.

2. Ease factor (lifestyle)

As the name sounds...this is how cushy the lifestyle is. Here, family practice and dermatology for example, will score high on this attribute.

3. Money factor

Self explanatory

4. Smarts factor

People in medicine generally enjoy intellectual work, or at least enjoy being seen by the public as highly intelligent.

 

Some examples

Plastics gets massive points for hotness, money, and intellectualism, but loses some points for lifestyle during residency. 95

Psych does not do well with hotness, intellectuality, and money, but scores high on ease- 71

 

Thoughts? I hope this can help future generations of medical students think of specialties rationally and systematically.

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I have been thinking the same thing lately. Although im just an M1 im starting to think about what I could potentially do later on in life, and many of the points you brought are interesting and do influence ones choice but there are also 2 important points I believe your missing.

 

Job prospects (some specialities are gonna be hard to get a job in a few years, mainly the surgical ones) and limitations/reality (some jobs can be more physically demanding i.e surgery and its not everyone that can be able to handle that kind of workload). Personally I have had knee problems all my life and am wondering if i would be able to handle the physical demands of a surgical lifestyle. I have always been interesting in possibly going into surgery, but lately I have been thinking that maybe its time to accept reality and realize that maybe its not ment to be. I guess we will truly know when i get into clerkship and get to try different specialities out.

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Job prospects (some specialities are gonna be hard to get a job in a few years, mainly the surgical ones) and limitations/reality (some jobs can be more physically demanding i.e surgery and its not everyone that can be able to handle that kind of workload). Personally I have had knee problems all my life and am wondering if i would be able to handle the physical demands of a surgical lifestyle. I have always been interesting in possibly going into surgery, but lately I have been thinking that maybe its time to accept reality and realize that maybe its not ment to be. I guess we will truly know when i get into clerkship and get to try different specialities out.

 

Ophthalmology ... you can sit while you operate!

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Throughout med school and residency, I pondered long and hard regarding what is the ideal specialty. There are just so many out there that I may be bewildering to choose. Should you be a family doctor or a psychiatrist? Or a general surgeon or a dermatologist? I think I have narrowed it down to four key attributes that defines a specialty. Let's call it Dongzhuo's HEMS of a specialty.

 

1. Hotness factor

This is how good a specialty sounds to laymen on the street. For example, saying you're a neurosurgeon has lots of hotness factor whereas saying you're a pathologist probably has a low score here.

2. Ease factor (lifestyle)

As the name sounds...this is how cushy the lifestyle is. Here, family practice and dermatology for example, will score high on this attribute.

3. Money factor

Self explanatory

4. Smarts factor

People in medicine generally enjoy intellectual work, or at least enjoy being seen by the public as highly intelligent.

 

Some examples

Plastics gets massive points for hotness, money, and intellectualism, but loses some points for lifestyle during residency. 95

Psych does not do well with hotness, intellectuality, and money, but scores high on ease- 71

 

Thoughts? I hope this can help future generations of medical students think of specialties rationally and systematically.

 

 

I think that there's likely a relative scale of importance between each factor that needs to be taken into account by each person when considering specialties in this way. E.g. for some people "hotness" might not matter at all whereas "ease" might be the first and foremost, in which case your example of plastics vs. psych might yield different results.

 

Also I'm not sure on this because I've yet to do any clinical training but I suspect that different people can have different views on what is "intellectual" and what is "easy". Going back to your example, I question whether someone might think that psychiatry, as a specialty that deals with the mind, is more intellectually involved than plastics. Again, no idea if that's actually the case, or if some specialties are just objectively not as "intellectual" because the things you do in them are simpler.

 

With respect to ease, I reckon there might be factors in play such as what type of lifestyle a person prefers (e.g. if someone loves shift work, EM might be easier for that person than for other people), what type of specialty one prefers (kinda seems circular but I do hear that doing what you love makes things better), and what kind of job environment one is planning to spend most time in.

 

My guess is that in the end, your model would be valid for someone who has a firm grasp of what they value and what each specialty specifically offers.

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To me, I like to think about what my ideal day as a physician would be like - practice setting, pace, type of patient, type of work.

 

The most important things to me are being able to practice in a community setting rather than a hospital, being able to have long term relationships with patients and being able to spend more time during each appointment, and working with more complex, "shades of grey" diagnoses and having time to stop and think before acting. I also want a specialty with a regular, predictable schedule and some flexibility in terms of work hours.

 

I think it's also important to know your strengths and weaknesses. I am very patient and I am able to manage patients with challenging behaviours and personality characteristics. But I struggle in high volume settings where I have to change tasks very quickly.

 

I have to say that money and public opinion don't really factor into it for me as much, at least for me right now.

 

I suppose you'd have to ask me in 20 years to see how right I am.

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Very interesting--Im just thinking about what scores high vs low using your criteria

 

Derm is likely best, as high in all 4 categories

 

General internal would probably be lowest--almost no "hotness", terrible lifestyle esp in residency, poor pay, high intellect

 

Neuro (my field) would do not so great, especially in comparison to physical med and rehab, the field I almost chose, which scores very poor on hotness but excellent on all other categories

 

Id be interested to hear how you would rank others than the ones you listed

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Derm is likely best, as high in all 4 categories

 

Don't know, the day-to-day practice is pretty boring. One of the reasons they can see a bazillion patients a day is because it's the same 4 things over and over and they are just more well-versed in steroids and antifungals. Did a derm elective, the doc told me he kept a log of all the conditions he saw over the course of one year of residency and he said 99% of the presentations were the same handful of things (SCC, BCC, melanoma, psoriasis, eczema, AK, seborrheic keratosis, warts, drug eruptions). The rare and wonderful are great, but the bulk of the practice is not that exciting.

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Throughout med school and residency, I pondered long and hard regarding what is the ideal specialty. There are just so many out there that I may be bewildering to choose. Should you be a family doctor or a psychiatrist? Or a general surgeon or a dermatologist? I think I have narrowed it down to four key attributes that defines a specialty. Let's call it Dongzhuo's HEMS of a specialty.

 

1. Hotness factor

This is how good a specialty sounds to laymen on the street. For example, saying you're a neurosurgeon has lots of hotness factor whereas saying you're a pathologist probably has a low score here.

2. Ease factor (lifestyle)

As the name sounds...this is how cushy the lifestyle is. Here, family practice and dermatology for example, will score high on this attribute.

3. Money factor

Self explanatory

4. Smarts factor

People in medicine generally enjoy intellectual work, or at least enjoy being seen by the public as highly intelligent.

 

Some examples

Plastics gets massive points for hotness, money, and intellectualism, but loses some points for lifestyle during residency. 95

Psych does not do well with hotness, intellectuality, and money, but scores high on ease- 71

 

Thoughts? I hope this can help future generations of medical students think of specialties rationally and systematically.

 

In general, hotness factor has a direct corollary to how difficult and serious the specialty is perceived. Things like neurosurgery and cardiology are hot in the public eye because of the training and how critical the brain and the heart are perceived. But that would mean hotness should be inversely correlated with ease/lifestyle factor. And it likely is. So you will always gain points in hotness factor and lose in lifestyle. So creating a point system is meaningless

 

Plastics is perhaps the least intellectual surgical subspecialty. It should get very little points for that. Ditto for Dermatology.

 

But different people will value different things more or less on your list and I guess thats what you're getting at but creating points is a bad idea.

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It goes into more details following the globe and mail article (from Nov 2013) about job prospects for residents to give you some idea about what the future holds.

 

I practice psychiatry. I can tell you that you need to know a lot of general medicine for this specialty and it you don't know your medicine (internal;endocrine etc) your won't help your patients as much as they need; there is a lot of co-morbidities that you need to be aware of and the complexity makes for an interesting career.

 

It is a very rewarding field of medicine with good lifestyle, increasing renumeration (relative to when I started); intellectually very stimulating for me; and there will always be shortages for psychiatry because its not perceived as a glamourous specialty and is on the lower end of the salary pay scale (for now but I see this improving all the time)

 

I would rather be doing this than continuing to sub-specialize in a field with no job at the end, limits being placed on OR time or older doctors who aren't into sharing their piece of the pie, a lot of overhead and maybe the need to relocate to find a job.

 

These are the other aspects of practice management that you don't always learn about or hear about when you are in med school. I love what I do and couldn't imagine what it would be like to put all those years into school and making all kinds of sacrifices only to have no job at the end or not the job you expected or invisioned you would have and ultimately being disappointed and possibly questioning why you went into medicine.

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I thought about individualizing the weighting for all the four attributes I listed, but then again it would lose all objectivity and end up being a meaningless endeavour. The goal Im trying to do is to create some sort of standardization- not unlike the macleans or us news rankings of the universities. It is to be taken with a grain of salt.

I actually plugged in some numbers for specialties and I think the 4 attributes have great predictive value in how competitive the field is.

 

Ophtho- very high scores for hotness, ease, money, and smarts. Also happens to be a very competitive specialty.

Radiology- not very hot to be a rads, but lifestyle good (debatable but dont have to deal with patients which may be great for some), excellent money, and pretty intellectual. Ends up being quite competitive.

Geriatrics- very poor scores for hotness and money. Lifestyle is good and could be intellectual. Not competitive

Family- low hotness, very chill, low income*, and not intellectual. Least competitive.

*income will be low if the family doctor practices in the traditional family model. If they do botox on the side or walk ins then its an entirely different story.

Emergency- hot (think the show ER), ease moderate (few hours worked but shift work), good money, moderate/low smarts. Moderately competitive.

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I dont disagree with that, but all those specialties are considered "lower income" as least relatively speaking. 300K gross would mean billings of about 500k. Certainly it is doable but I would say that's the 75th percentile for family docs.

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Dongzhuo, you're mixing up gross and net. $300K gross means $300K billings. Then take out overhead ($100K), and tax ($70K), and you're left with $130K net.

 

*sample numbers, not necessarily representative*

 

Oops. The number looked too low for gross so got confused that it was net. No one working as a physician should be taking home anything in the 100's......

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Damn 130 as a physician? Seems too low to be taken seriously.

 

I would tend to believe this. I've heard similar numbers for FM, but they weren't necessarily killing the bookings either.

 

I know plenty of pharmacists who take home this much. In the end, it's a lot of cash still.

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Radiology is no longer competitive. The interest has taken a nose dive. Last year was suppose to be very chill and this year was even more chill..

 

I thought about individualizing the weighting for all the four attributes I listed, but then again it would lose all objectivity and end up being a meaningless endeavour. The goal Im trying to do is to create some sort of standardization- not unlike the macleans or us news rankings of the universities. It is to be taken with a grain of salt.

I actually plugged in some numbers for specialties and I think the 4 attributes have great predictive value in how competitive the field is.

 

Ophtho- very high scores for hotness, ease, money, and smarts. Also happens to be a very competitive specialty.

Radiology- not very hot to be a rads, but lifestyle good (debatable but dont have to deal with patients which may be great for some), excellent money, and pretty intellectual. Ends up being quite competitive.

Geriatrics- very poor scores for hotness and money. Lifestyle is good and could be intellectual. Not competitive

Family- low hotness, very chill, low income*, and not intellectual. Least competitive.

*income will be low if the family doctor practices in the traditional family model. If they do botox on the side or walk ins then its an entirely different story.

Emergency- hot (think the show ER), ease moderate (few hours worked but shift work), good money, moderate/low smarts. Moderately competitive.

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Damn 130 as a physician? Seems too low to be taken seriously. Anybody have evidence/ link to verifying this??

 

If they are in a capitation type of practice they may gross up to 300k or more depending on their roster size and other factors like supplemental income (nursing homes, walk in clinics)

 

When you factor in overhead costs and taxes, I would say that a teacher or vice principal may be close in terms of what take home pay a family doctor may get without the weeks of holidays and pension.

 

Some of the newer doctors out in practice comment about this a lot and try to seek alternative income streams in medicine but are unfortunately on pace for burning out and developing compassion fatigue.

 

If money is going to be the biggest motivating factor for deciding on a specialty some med students I think will be disillusioned by what they actually make and as the job prospects are looking right now, they may not have a job in the end.

 

Money isn't everything, lifestyle in my opinion can easily trump money and if you are too busy working to enjoy the life you envisioned having, is that really worth it.

 

Do you want to be the doctor whose kids never see their mom or dad if you are also currently or foresee being a parent.

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Full-time regular-practice family doctors simply don't make an "extraordinary" amount of money. It doesn't compensate for the training and type of work you do. Even the highest provincial average earnings are barely above other professionals with far less years of training and cushy lifestyles OR even non-professionals. In addition, when you take into the number of hours worked per week and lack of paid vacation and benefits for family doctors, there's no wonder why they either burn out or seek lucrative practice methods. Can someone live comfortably with 130k? Definitely- and if that's all you're concerned about, then fine. But not everyone is fine with being underpaid.

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Full-time regular-practice family doctors simply don't make an "extraordinary" amount of money. It doesn't compensate for the training and type of work you do. Even the highest provincial average earnings are barely above other professionals with far less years of training and cushy lifestyles OR even non-professionals. In addition, when you take into the number of hours worked per week and lack of paid vacation and benefits for family doctors, there's no wonder why they either burn out or seek lucrative practice methods. Can someone live comfortably with 130k? Definitely- and if that's all you're concerned about, then fine. But not everyone is fine with being underpaid.

 

Lol at being underpaid. Sounds like someone who has no clue what being underpaid ACTUALLY is.

 

Most of you wouldn't be able to make what a physician does, even a lowly underpaid one, if your goal wasn't to be one.

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If you want to earn less than your medical colleagues and only slightly more/ less than your college friends who finished school years before you, go ahead - you'll still live comfortably. If you wanted to live comfortably you didn't have to do all these years of medical training. But for the purposes of this thread, OP is quantifying income as a deciding factor for choosing a specialty, and there's nothing wrong with that.

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If they are in a capitation type of practice they may gross up to 300k or more depending on their roster size and other factors like supplemental income (nursing homes, walk in clinics)

 

When you factor in overhead costs and taxes, I would say that a teacher or vice principal may be close in terms of what take home pay a family doctor may get without the weeks of holidays and pension.

 

Some of the newer doctors out in practice comment about this a lot and try to seek alternative income streams in medicine but are unfortunately on pace for burning out and developing compassion fatigue.

 

If money is going to be the biggest motivating factor for deciding on a specialty some med students I think will be disillusioned by what they actually make and as the job prospects are looking right now, they may not have a job in the end.

 

Money isn't everything, lifestyle in my opinion can easily trump money and if you are too busy working to enjoy the life you envisioned having, is that really worth it.

 

Do you want to be the doctor whose kids never see their mom or dad if you are also currently or foresee being a parent.

 

Words of wisdom.

 

LOL at ppl here who think $130K TAKE-HOME is not an extraordinary amount of money.

 

Of course it is still a lot of money but in terms of being an MD it is quite low. 1/5th of what a lot of specialities make.

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