Help me pick a specialty

[Nirvanesthesia]

I've been spending so much time thinking about this and haven't gotten super far, so I'm curious to hear what specialties you guys think I should further consider.

- I'm introverted. I enjoy both independent work and patient interaction/working with others, but I would prefer something that doesn't involve talking all day.

- I am very passionate about tech, data, and innovation in medicine. 

- I enjoy the idea of being the expert in something but I don't want to be super specialized.

- I like variety; I get bored easily.

- I am a creative person so I would like to be able to think creatively in my work. I also like the arts and humanities.

- I would prefer some acuity to keep things interesting but not the extreme as that would make me too anxious.

- I like the idea of doing some procedures as it would be nice to directly solve patient problems.

- I'm willing to work hard but would like to have a life outside of my work. 

[offmychestplease]

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[1D7]

1 hour ago, Nirvanesthesia said:

I've been spending so much time thinking about this and haven't gotten super far, so I'm curious to hear what specialties you guys think I should further consider.

- I'm introverted. I enjoy both independent work and patient interaction/working with others, but I would prefer something that doesn't involve talking all day.

- I am very passionate about tech, data, and innovation in medicine. 

- I enjoy the idea of being the expert in something but I don't want to be super specialized.

- I like variety; I get bored easily.

- I am a creative person so I would like to be able to think creatively in my work. I also like the arts and humanities.

- I would prefer some acuity to keep things interesting but not the extreme as that would make me too anxious.

- I like the idea of doing some procedures as it would be nice to directly solve patient problems.

- I'm willing to work hard but would like to have a life outside of my work. 

It's difficult to find something that fits all of that.

What fits best is 'general' radiology in a community hospital handling a mix of ER, inpatient medical/surgical, and outpatient cases with a few biopsy/drain cases here and there. You'll work with the whole body handling mostly adult but with some paediatric cases as well. It's technological with constant advances and shifts in technology. IR in an academic setting can also tick many of these boxes, but you will work with high acuity, sick patients relatively often (life & death situations with bleeders at a minimum and in some centres you are in the call pool to handle EVARs and cold limbs).

If you have a particular interest in any body part, the various disease entities can feel somewhat varied. Otherwise neurology and the IM subspecialties probably aren't what you're looking for. I also don't think most surgical specialties fit what you're asking for. If you want variety often it means working further away from academic centres, which also means you'll be on call more often and have to be comfortable handling high acuity cases without immediate backup. Plus residency/fellowship will challenge your work-life balance.

 

[rmorelan]

3 hours ago, offmychestplease said:

Interventional Radiology seems like it was made for you but with the caveat being are you willing to spend 6-7 years of gruelling residency and fellowship to have a chance at a job post-medical school like most FRCPC fields.

only draw back there based on the criteria is the frequent call an IR rad would have. Usually they fewer IR rads at a centre the more call but as the centre is smaller probably less intense call (flipped the other way for larger centres). 

but as others point out rads is a possible - particularly a general rad (each day different modalities, 30% of the work is procedures in community rad, some acute care, know something about everyone's field as you support all fields, can have a good work/life balance although no longer really ROAD worthy in my mind, and the most tech dependent field there is). Rad onc (which I almost went into) is a possibility as well on the face of it (the procedure is the radiation - you literally destroy their cancer hopefully). 

some fields of surgery if set up correctly may also apply. 

just off the top of my head.  

[robclem21]

Anesthesia hits almost all of those

[garlic]

On 9/26/2020 at 9:26 PM, rmorelan said:

only draw back there based on the criteria is the frequent call an IR rad would have. Usually they fewer IR rads at a centre the more call but as the centre is smaller probably less intense call (flipped the other way for larger centres). 

but as others point out rads is a possible - particularly a general rad (each day different modalities, 30% of the work is procedures in community rad, some acute care, know something about everyone's field as you support all fields, can have a good work/life balance although no longer really ROAD worthy in my mind, and the most tech dependent field there is). Rad onc (which I almost went into) is a possibility as well on the face of it (the procedure is the radiation - you literally destroy their cancer hopefully). 

some fields of surgery if set up correctly may also apply. 

just off the top of my head.  

Why is community rads no longer ROAD whereas academic is in your estimation? (I guess none of the ROAD specialties are very ROAD anymore, but it's always nice to hear your opinion/insight, @rmorelan)

[rmorelan]

2 hours ago, garlic said:

Why is community rads no longer ROAD whereas academic is in your estimation? (I guess none of the ROAD specialties are very ROAD anymore, but it's always nice to hear your opinion/insight, @rmorelan)

I wouldn't even say academic rads is the ROAD field of days long gone either 

when people started to call it that no one had any expectation of radiology doing anything quickly - I mean even the entire transcription process and sending out reports (by mail or fax ha) took days. No one could see any of the imaging either other than radiology. 

Now the entire hospital runs on large part on imaging. It rare to have someone admitted or discharged before we have a study to read on them - that make everything much faster. 

There have been a lot of cuts to radiology fees over the last decade - income didn't fall though because demand for imaging kept going up. So we just worked harder, and harder and harder still to stay where we were. The volumes have at least doubled in many places. That means we are constantly on the go - rads used to take this thing called a lunch. Now we are basically glued to the computer the entire shift (I have shifts where I cannot get out of the chair basically for several hours at a time). New grads find themselves not able to even do the work initially - often starting at 80% of the "Full time" volume and working very long days to even to that. 

And now there is call - a lot more of it. Prior it was gone by 5pm at the latest. Now someone is usually there academic or community till 11-12 or so (maybe not going none stop but still not exactly free to do anything else). Overnight services have started to pop up as well - something that is gaining momentum. You just cannot run an ER without quick imaging - and both volume and complexity is making it very hard to use the old models. 

So we are paid well but we now work for it (prior in comparison we didn't - if you every do a nuc med rotation - they have it now basically like we used to. That is not a criticism - I think the rise of burnout and dissatisfaction in rads is often from the loss of what was before  and the treadmill of work we have put ourselves on. 

Edited September 29, 2020 by rmorelan