Ranking ROAD

[A-Stark]

It shouldn't be forgotten that EM needn't be done through the Royal College program, and in sheer numbers there must be far more Emerg docs around who've gone the CFPC-EM route. It's really too bad the whole matching process is not set up to allow more career flexibility, though maybe that will start to change again in the not-too-distant future.

[Dongzhuo]

why isn't ORL on the ROAD list? it's a very lucrative specialty with a very good life style

 

what's ORL?

[Mandibular]

otorhinolaryngology (thats like 1000 points in scrabble)

[apache]

per hour, psych is undoubtedly one of the best paid:

 

http://www.health.gov.bc.ca/msp/infoprac/physbilling/payschedule/pdf/29.%20psychiatry.pdf

 

Individual Psychotherapy (you have to spend about 75 percent of the time actually doing the therapy, the other 25 percent can be reviewing notes, etc.

 

(office or hospital out-patient):

00630 - per 1/2 hour 89.46

00631 - per 3/4 hour 124.69

00632 - per 1 hour 159.64

 

Office visit to include services such as chemotherapy management and/or

minimal psychotherapy 44.75

 

I shadow a psychiatrist who does 30 min sessions = 89.46 + 44.75 med management = 134.21 per 30 minutes of your time.

 

Add this to minimal overhead, the potential for monumental write offs and the ability to specialize your practice to patients you can handle emotionally (for me mostly disorders I believe psych can help at this point in its development... mostly the ones I mentioned in my earlier post) and this becomes a sick specialty... you can incorporate, don't have to be staff at a hospital, and make ridiculous money, while controlling your hours, plus share overhead with 3 or 4 other shrinks and hire some psychologists, pay them 80 an hour (which they'll take because of high patient referral and bill 130 an hour and you've got a plan for ridiculous money, great lifestyle...

 

 

 

I thought psych and peds (general I guess, subspecialties probably vary) were some of the most poorly paid specialties?

[apache]

Being a LASIK doc + 1.5 million a year still = death

 

 

LOL I chuckle at the idea of "probably ONLY average around 650-750 K (post expense, pre tax)"....and that's POST expenses and tax?

 

Yea seriously the government should do something about these lifestyle specialties. It's getting kind of ridiculous...it's not like the knowledge base or skill set they have are really that much more than other specialties. Like I undesrtand specialists generally make more than family docs per consult, and they do have additional training etc. But what makes ROAD so much more supposedly challenging that they get to reap so many benefits?

 

Lol, maybe I'm just bitter because my interests don't lie in a specialty that will earn me millions and I refuse to enter something just for money after all this schooling.

[apache]

I think derm and optho salaries really need to be sliced in half... for optho their pay hasn't caught up with the fact that the procedures take an 8th of the time to do now... derm at a million plus... seriously that's pathetic when there are IM docs saving peoples lives at a third of the salary

 

For me Rads and Anes deserve their salaries, the knowledge-base in radiology is ridiculous.. tons of respect... Anes also has such a huge knowledge-base and potential for disaster with a dec call sched that they deserve it, imo

 

personally i think anesthesia seems the most exciting out of the bunch... i like the cerebral nature of rads, but i've seen them in their dark rooms all day and i couldn't do that

 

Personally though, i think I can handle the Porsche over a couple Lambo's, this is Canada after all...

 

ROAD - I like R, O and D. Lots of money, good hours, tons of respect. Anesthesia however seems boring, and high risk. Not to mention really early hours.

 

Interventional Radiology and Opthalmology are easy 1 million plus jobs with really good hours and lifestyle (yes there is some call for IR - but it's nowhere near surgery levels). Dermatology is the best lifestyle, but in Canada I don't think the money is as good as R and O. I think they barely make a million at most...and probably only average around 650-750 K (post expense, pre tax). But the lower pay is compensated by a great lifestyle, as well as a chance to make money by sponsering skin care products (if that is something you are interested in).

 

I'm only really interesteded in Optho for myself out of ROAD, but could see myself doing Cardiology through IM. We'll see...I'm only 1st yr.

[Jochi1543]

otorhinolaryngology (thats like 1000 points in scrabble)

 

We call it ENT (ear, nose, throat) in the English-speaking part of Canada/US.

[Jochi1543]

Derm is only at 500K+ because of cosmetic procedures. Insurance billings are same as for any IM specialist (200-300).

[lostintime]

Can't family docs also do cosmetic procedures? So potentially they could add another 100-200k to their salary?

 

And how is the knowledge base for rads or anesthesia more than internal? I dunno....Derm actually requires a pretty large knowledge base, since a lot of systemic diseases manifest through the skin.

[A-Stark]

Any MD can do cosmetic procedures. I also don't agree that rads or anesthesia have particularly greater knowledge bases than IM (or gen surg for that matter). I haven't ruled out anesthesia for myself just yet, but it's anything but exciting most of the time. Good if you like to read the paper while at work.

[Melisende]

Ophtho has great pay IF you have access to the OR. OR time is hard to come by if you just graduated and want to live in a city, so many recent ophtho grads end up doing office ophtho which doesn't pay half as well as the procedural stuff.

[jdai]

Family med is where it's at yo.

It's about supply and demand. There's a HUGE demand for family right now, shortages everywhere, and you know they are getting better pay year by year.

 

Not to mention, be your own boss, work whenever you want, wherever you want, not tied to hospital or university, unlimited vacation time, allows for impulsive time off, do anything you want to do, sky's the limit, make initial diagnosis, and low stress.

 

 

My thoughts on ROAD:

 

Radiology isn't as easy job as it once were. More and more diagnosis need imaging, and imaging devices are becoming more widespread and used more frequently. This just means more work for the radiologist and more calls. At the same time, their pay hasn't really increased that much.

 

Derm is, well, derm. I'll let you know more once I finish my elective.

 

Ophthal is very cool IMO because diagnosis are made on the spot, and treatment also done very quickly. Many people rate sight over their life. It's rewarding IMO. But it's also an all or nothing specialty. Either you go all out from year 1 (e.g. research projects, electives, volunteering, shadowing) in ophth, or you don't go at all. Super competitive. Also, if you ever get good at one thing (e.g. treating diabetic retinopathy), you are pigeon-holed into doing it for the rest of your life. It's like a super-subspecialization. There's no "general ophthalmologist" out there that sees everything. It gets really boring after a while.

 

Anes. Well it's 95% boredom 5% chaos. Kinda like ER docs only for those 95% you aren't seeing bread and butter patients, you are kicking back in the OR bored out of your skull. When **** hit fan though, you have to know your stuff. Not to mention early mornings, calls, and working at the surgeon's schedule. If an operation goes overtime, sorry bud you stay right there. This is why sometimes Anes gets annoyed at med students/junior residents taking half an hour to close up an operation.

[Satsuma]

yeah the hard part is prior to the surgery etc. People just don't seem to get that

 

That reminds me of a pt I saw while doing my anest rotation. I, as always, introduce myself as the resident working with the anesthesiologist. Do my hx, exam and proceed to explain what will happen in the OR. I then ask if she has any questions. And she says, not really, but just want to be sure that everyone knows that I don`t want any residents involved in my case.

 

I pause...and think to myself, I'm pretty sure I told her I was a resident. So I say again, well I am resident, do you not want me involved in your care?

 

And she says...oh no, I don`t care if you are involved I just don`t want any resident surgeons.

 

So - worked out for me 'cause otherwise I would have had to have scrambled to find another case for the morning. But clearly she had no idea, that I would be the one that could kill her in under 5 minutes!

[NLengr]

That reminds me of a pt I saw while doing my anest rotation. I, as always, introduce myself as the resident working with the anesthesiologist. Do my hx, exam and proceed to explain what will happen in the OR. I then ask if she has any questions. And she says, not really, but just want to be sure that everyone knows that I don`t want any residents involved in my case.

 

I pause...and think to myself, I'm pretty sure I told her I was a resident. So I say again, well I am resident, do you not want me involved in your care?

 

And she says...oh no, I don`t care if you are involved I just don`t want any resident surgeons.

 

So - worked out for me 'cause otherwise I would have had to have scrambled to find another case for the morning. But clearly she had no idea, that I would be the one that could kill her in under 5 minutes!

 

I love these patients. They seem to think that the surgeon has 8 hands and can do everything without help...

 

They also prove that they don't read what they sign since our consent agreement specifically states the surgeon and anesthesiologists have final say over procedures, drugs and who is in the room.

[neuropathy123]

People should know the downsides of these specialties as well.

 

R - radiology. You will be buried in books for your residency simply to learn the vast amount of knowledge you need. Imagine you'll have to know disease from EVERY specialty, at the level of a specialist besides management. Call is **** and you will be the busiest person in the hospital. While you may feel like a king on call in charge of the hospital, be sure there will be no sleep, not a drop.

 

O - ophthal. First there is NO OR time anywhere in decent city. New grads are expected to make 100-150k running offices for the established guys, who will reserve OR time for their family / relatives, or have fellows operate while they observe and bill. Be prepared to suck up since day one of medical school, through residency, and beyond to get into the field and find a job.

 

A - anesthesia. Biggest downside is lack of respect, and that you'll have to do call for the rest of your life. And those calls are busy as you'll be in the OR. I often see those in their 40's and 50's still running the OR at night, which you don't see with those others in ROAD and even IM. Money is certainly the lowest of ROAD.

 

D - derm. Good lifestyle and easy to find work or establish your own clinic. Pay on average is around the same as A, but less than O & R. Be prepared that EVERY family doc think he/she is also a dermatologist, and will get into the cosmestic side as those are still easy procedures, run their on UV lights in office, and NOT refer to derm unless there is complication or the case is difficult.

 

P - pathology. Jobs are HARD to come by in a decent city. You will be the most isolated person in the hospital, with lack of contact with both the patients and referring docs. Looking into the microscope 5-6 hours a day simply SUCKS. Pay is ok, similar to A & D.

 

E - Emergency. shift work sucks and you'll have to do it for the rest of your life, especially those 11pm-7am ones. You get DISSED by every specialist (including junior residents), always begging for help with admission and consults, and always begging the radiology to approve a scan. You'll have to deal with angry patients who's waited for 6-7 hours.

 

P - psych. There is reason why no one else in hospital want to deal with psych issues - those patients are hard to deal with. At least you are paid for your time rather than giving free counseling that family docs are expected to do.

[Lactic Folly]

Interesting post above - thanks.

[trymeover]

neuropathy123, please post more often. That was a super post.

[Dongzhuo]

People should know the downsides of these specialties as well.

 

R - radiology. You will be buried in books for your residency simply to learn the vast amount of knowledge you need. Imagine you'll have to know disease from EVERY specialty, at the level of a specialist besides management. Call is **** and you will be the busiest person in the hospital. While you may feel like a king on call in charge of the hospital, be sure there will be no sleep, not a drop.

 

O - ophthal. First there is NO OR time anywhere in decent city. New grads are expected to make 100-150k running offices for the established guys, who will reserve OR time for their family / relatives, or have fellows operate while they observe and bill. Be prepared to suck up since day one of medical school, through residency, and beyond to get into the field and find a job.

 

A - anesthesia. Biggest downside is lack of respect, and that you'll have to do call for the rest of your life. And those calls are busy as you'll be in the OR. I often see those in their 40's and 50's still running the OR at night, which you don't see with those others in ROAD and even IM. Money is certainly the lowest of ROAD.

 

D - derm. Good lifestyle and easy to find work or establish your own clinic. Pay on average is around the same as A, but less than O & R. Be prepared that EVERY family doc think he/she is also a dermatologist, and will get into the cosmestic side as those are still easy procedures, run their on UV lights in office, and NOT refer to derm unless there is complication or the case is difficult.

 

P - pathology. Jobs are HARD to come by in a decent city. You will be the most isolated person in the hospital, with lack of contact with both the patients and referring docs. Looking into the microscope 5-6 hours a day simply SUCKS. Pay is ok, similar to A & D.

 

E - Emergency. shift work sucks and you'll have to do it for the rest of your life, especially those 11pm-7am ones. You get DISSED by every specialist (including junior residents), always begging for help with admission and consults, and always begging the radiology to approve a scan. You'll have to deal with angry patients who's waited for 6-7 hours.

 

P - psych. There is reason why no one else in hospital want to deal with psych issues - those patients are hard to deal with. At least you are paid for your time rather than giving free counseling that family docs are expected to do.

 

Thanks for the enlightening post. Which one of these would you choose, if any?

[Guest success100]

Awesome point of view !Very honest and clear...Thanks for the feedback !

It would be nice to have this kind of infos for EACH specialties...

That would be less confusing for most people...

[Jochi1543]

I liked neuropathy's post. I feel like a lot of people think that ROAD is some sort of promise land, whereas all these specialties definitely have their downsides. I wanted to add re: dermatology - there is also a huge volume of knowledge and a lot of cross-referencing with other specialties and subspecialties, e.g. infectious disease or oncology.

[Mandibular]

I dont know how it is for the rest of canada, but for Quebec, with the constant increases in salary for family med, the whole family med+ emergency (2+1) seems like a pretty sweet deal: primary care with variability, not an uber-specialty with a sub specialty where all you do all day is see similar type cases!

[illa]

D by far! if i end up going to med school i would LOVE to be a dermatologist, at the momment its the only speciality i'm thinking about

[leviathan]

D by far! if i end up going to med school i would LOVE to be a dermatologist, at the momment its the only speciality i'm thinking about

From a pre-med perspective, what about dermatology entices you?

[RyanMaverick]

Is there any specialties where a pharmacy degree (and hospital residency) would come in handy? It seems like FM would give me the best use of both degrees due to pharmacy training in chronic disease management, but is there any specialties which might be beneficial as well?

 

My impression is that ROAD, EM, etc would not use it at all, while something like Pysch or IM could allow me to use that knowledge as well.

[2014?]

Anesthesia is a whole lot of drugs... albeit different drugs than chronic disease management. But I know a few anesthetists with pharmacy/pharmacology backgrounds.