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Procedure-heavy specialties


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Hi,

I started medical school after leaving a PT BSc and was almost dead set on orthopedic surgery which would still be my dream specialty if it wasn't for two realisations I made: 1) I'd like to have a life 2) I'd like to have a job. Because of those, I figured I should pursue another specialty.

As my interest for surgery suggests, I'm seeking a specialty that's procedure-heavy and decent when it comes to lifestyle. It doesn't have to be the cushiest but hopefully easier that surgery. The pay does matter but that's not make or break for me. So far, I've narrowed it down to a few that could fulfill what I'm looking for:

Anesthesiology

Pros: Lots of procedures, very good remuneration, good lifestyle from what I understand, possibility to do lots of different things like critical care, pain clinics, etc., heard that residency isn't too bad outside of call

Cons: Reasonably competitive in CARMS (could be a problem since my school is grade based and so far my GPA is slightly above average but by no means extraordinary, not sure how anglophone schools treat GPAs from french schools)

Radiology

Pros: Possibility to go into IR and do a ton of extremly interesting procedures, heard that residency isn't too bad outside of call, seems interesting to me even if I don't end up doing IR

Cons: See anesthesiology regarding CARMS, IR is as hectic if not more than surgery

Physiatry

Pros: By far the best lifestyle of those three, possibility to do lots of procedures like infiltrations or nerve blocks, lots of subspecialties, fantastic job market in Quebec and that's not gonna change with the aging population

Cons: Remuneration is not that good, not sure why but I'm stuck with the idea that it's boring, might regret doing MSK but not going for orthopedics

Some other questions I have:

- What are some of the procedures you can do in each of these specialties?

- Any other specialties you can think of (ideally outside of IM subspecialties since I can't stand IM from the little exposure I've had so far).

So that's about it. If someone could enlighten me and share their thoughts about the specialties, I'd be very happy to hear from you! :)

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Notwithstanding your common interest in tailoring your practice to be procedure-heavy, these specialties are quite distinct from each other, and you'd want to make sure you are a good fit for the core of each specialty to make it through the training. Doing some observerships early on in medical school would likely be very beneficial in providing more insight.

Some points to consider:

Anesthesiology - OR environment (major factor here, not present in the other two). Nature of practice, ranging from uneventful cases to crashing patient (sheer terror) - at least that's how it appears to someone who didn't choose anesthesiology for that reason ;)

Radiology - Major areas of IR are oncology and vascular (plus neuro IR). If interested in ortho, MSK procedures may be more interesting to you - biopsy, injections, etc. How procedure-heavy does your day need to be?  Is several procedures during a day, a few days per week as an MSK radiologist enough? Do you enjoy the diagnostic aspect of radiology? Even an IR will have non-IR days, and of course they need to be proficient reading studies as well.

Physiatry - quite different from the other two in that you work with patients over a longer term, coordinate multidisciplinary teams to the best of my knowledge.

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19 minutes ago, Lactic Folly said:

Notwithstanding your common interest in tailoring your practice to be procedure-heavy, these specialties are quite distinct from each other, and you'd want to make sure you are a good fit for the core of each specialty to make it through the training. Doing some observerships early on in medical school would likely be very beneficial in providing more insight.

Some points to consider:

Anesthesiology - OR environment (major factor here, not present in the other two). Nature of practice, ranging from uneventful cases to crashing patient (sheer terror) - at least that's how it appears to someone who didn't choose anesthesiology for that reason ;)

Radiology - Major areas of IR are oncology and vascular (plus neuro IR). If interested in ortho, MSK procedures may be more interesting to you - biopsy, injections, etc. How procedure-heavy does your day need to be?  Is several procedures during a day, a few days per week as an MSK radiologist enough? Do you enjoy the diagnostic aspect of radiology? Even an IR will have non-IR days, and of course they need to be proficient reading studies as well.

Physiatry - quite different from the other two in that you work with patients over a longer term, coordinate multidisciplinary teams to the best of my knowledge.

I chose not to do any research this summer to leave myself with enough time to shadow in these specialties. I've had exposure to orthopedics and rehabilitation (but not physiatry itself) from my time in PT so at least I know I like MSK. Now it's time to see what the others are like.

Regarding anesthesiology and radiology, the classes I've had taught by those specialists peaked my interest, hence my curiosity.

In terms of what I'd consider "enough" procedures, I'd say a day/week doing IR (isn't that the norm?) would satisfy me with a few other cases here and there. I guess anesthesiology would be more steady since you'd have to induce anesthesia every time, souldn't you?

I do know physiatry is a long game and involves a lot of teamwork. These are things I don't mind at all. I'm just afraid that it's going to be more planning and less action than I thought.

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1 day/week doing procedures with a few others scattered throughout the week isn't that heavy IMO. If an IR only does one day/week as you suggested, a hospital would need at least 5 IRs per suite, with zero allowance for time off. 20% would also be unlikely to satisfy someone who chose to pursue an interventional career.

I don't know how many days/week anesthesiologists typically spend in the OR (I would think it's a majority), but during those days, I'd expect them to be similarly fully booked with cases.

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2 hours ago, Snowmen said:

In terms of what I'd consider "enough" procedures, I'd say a day/week doing IR (isn't that the norm?) would satisfy me with a few other cases here and there. I guess anesthesiology would be more steady since you'd have to induce anesthesia every time, souldn't you?

There would usually be a day in pre-admission clinic a few times a month, but otherwise it is entirely OR based (provided there's no subspecialty like ICU or pain) +/- academic and/or administrative commitments. You kinda have to be comfortable staying vigilant and thinking about badness even while doing sedations. 

 

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7 hours ago, Lactic Folly said:

1 day/week doing procedures with a few others scattered throughout the week isn't that heavy IMO. If an IR only does one day/week as you suggested, a hospital would need at least 5 IRs per suite, with zero allowance for time off. 20% would also be unlikely to satisfy someone who chose to pursue an interventional career.

I don't know how many days/week anesthesiologists typically spend in the OR (I would think it's a majority), but during those days, I'd expect them to be similarly fully booked with cases.

I figured IR would be a little like surgery where a general surgeon would operate 1 day/week and scope 1 day/week on average, but the more the better then!

5 hours ago, A-Stark said:

There would usually be a day in pre-admission clinic a few times a month, but otherwise it is entirely OR based (provided there's no subspecialty like ICU or pain) +/- academic and/or administrative commitments. You kinda have to be comfortable staying vigilant and thinking about badness even while doing sedations. 

 

Having to be doing something or always having to be on your guard is exactly what I'm looking for. In more "read-heavy" specialties like what I've seen of IM so far, I feel like I'd fall asleep while reading charts and lab results. Radiology seems different to me since, from the small experience I have, I actually like looking at imaging results (despite having no idea what I'm seeing).

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18 hours ago, Snowmen said:

Having to be doing something or always having to be on your guard is exactly what I'm looking for. In more "read-heavy" specialties like what I've seen of IM so far, I feel like I'd fall asleep while reading charts and lab results. Radiology seems different to me since, from the small experience I have, I actually like looking at imaging results (despite having no idea what I'm seeing).

Well, I wouldn't say that as a staff anesthetist (or even a resident) you'd be wound up and "on guard" during a day of outpatient joints or lap choles or hernias. It's probably better to say anesthesia combines all the fun of waking up very early, sitting still, and paying attention. You'll have to do an awful lot of reading/studying before that exam. 

One thing I'm wondering, though, is whether you're interested in just doing some procedures here and there or whether you want to be a surgeon. GI and cardio offer more of a surgery-style rhythm to the day (or can). 

Basically, if you love the OR and cannot imagine not operating, go into surgery (of one kind or another, keeping in mind that there's rather a wide range of things). If you like the OR and (often stressful) hospital environment, and also love physiology and pharmacology most of all, consider anesthesia. If you like looking at pictures in a dark room and doing some fluoro while shooting dye into vessels and advancing expensive wires, radiology might be a good choice. I can't speak to physiatry, but they definitely do fluoro and other interventional stuff about which I have scarcely any knowledge. 

I'm not sure what kind of IM exposure you've had so far, but "reading" is a part of any specialty all the time. And nothing has ever made me sleepier than when I did a radiology elective in clerkship. 

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6 hours ago, A-Stark said:

Well, I wouldn't say that as a staff anesthetist (or even a resident) you'd be wound up and "on guard" during a day of outpatient joints or lap choles or hernias. It's probably better to say anesthesia combines all the fun of waking up very early, sitting still, and paying attention. You'll have to do an awful lot of reading/studying before that exam. 

One thing I'm wondering, though, is whether you're interested in just doing some procedures here and there or whether you want to be a surgeon. GI and cardio offer more of a surgery-style rhythm to the day (or can). 

Basically, if you love the OR and cannot imagine not operating, go into surgery (of one kind or another, keeping in mind that there's rather a wide range of things). If you like the OR and (often stressful) hospital environment, and also love physiology and pharmacology most of all, consider anesthesia. If you like looking at pictures in a dark room and doing some fluoro while shooting dye into vessels and advancing expensive wires, radiology might be a good choice. I can't speak to physiatry, but they definitely do fluoro and other interventional stuff about which I have scarcely any knowledge. 

I'm not sure what kind of IM exposure you've had so far, but "reading" is a part of any specialty all the time. And nothing has ever made me sleepier than when I did a radiology elective in clerkship. 

Radiology is basically nap time. 

The other thing with IR is you need to be ok with sitting on your butt in an office all day during your non procedure days. Some people are cool with that, some hate it. 

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9 hours ago, A-Stark said:

Well, I wouldn't say that as a staff anesthetist (or even a resident) you'd be wound up and "on guard" during a day of outpatient joints or lap choles or hernias. It's probably better to say anesthesia combines all the fun of waking up very early, sitting still, and paying attention. You'll have to do an awful lot of reading/studying before that exam. 

One thing I'm wondering, though, is whether you're interested in just doing some procedures here and there or whether you want to be a surgeon. GI and cardio offer more of a surgery-style rhythm to the day (or can). 

Basically, if you love the OR and cannot imagine not operating, go into surgery (of one kind or another, keeping in mind that there's rather a wide range of things). If you like the OR and (often stressful) hospital environment, and also love physiology and pharmacology most of all, consider anesthesia. If you like looking at pictures in a dark room and doing some fluoro while shooting dye into vessels and advancing expensive wires, radiology might be a good choice. I can't speak to physiatry, but they definitely do fluoro and other interventional stuff about which I have scarcely any knowledge.

I'm not sure what kind of IM exposure you've had so far, but "reading" is a part of any specialty all the time. And nothing has ever made me sleepier than when I did a radiology elective in clerkship. 

My school has a 2 week observation period where we rotate through many specialties in first year. I spent 2 days in IM and I honestly couldn't stand it as you spend most pretty much no time with patients and the work is very slow paced. I spent a day in intensive care and that was already more hands on and active so that's something I definitely could see myself doing. I like problem solving and the likes but the pace in IM is too slow for me whereas it is much quicker in anesthesia (when you need to problem solve) and anesthesia can lead to intensive care. What worries me about physiatry is that despite covering my MSK interest, it doesn't seem that far from IM in terms of practice style.

I spent half a day in radiology and that was already better. As you can guess from my interest in surgery, I love anatomy and therefore, despite still being reading in a way, radiology seems way more interesting to me because of the huge anatomy component. On top of that, you can do IR for a day or two every week and do procedures that, to me, look very interesting.

As you mentioned, surgery would obviously fit the bill of fast pace and procedures. I've gone to the OR a few time already and loved it but couldn't bring myself around the fact that exactly 100% of the surgery resident I've seen looked miserable. Add the fact that I'm an actively competing road cyclist and that maintaining decent shape would require 10-12 hours of training per week and the surgery schedule becomes a big problem. I want to do procedures but I'm not willing to waste my best years (24-29) being stuck in the hospital 80-100 hours/week (even though all residency obviously are demanding).

Thanks for all the opinions so far, that is very appreciated! :)

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Might want to consider EM? We got a diverse array of procedures. Some of them performed under the highest stakes conditions. It might appeal to you. 

If you are okay with shift work the lifestyle is not shabby. 

EM also can lead to intensive care.

As a clerk I was all about General Surgery. So happy I saw the light of the ED. One of the smarter things I've done over the years. ;)

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20 minutes ago, rogerroger said:

Might want to consider EM? We got a diverse array of procedures. Some of them performed under the highest stakes conditions. It might appeal to you. 

If you are okay with shift work the lifestyle is not shabby. 

EM also can lead to intensive care.

As a clerk I was all about General Surgery. So happy I saw the light of the ED. One of the smarter things I've done over the years. ;)

I would strongly consider it if the situation wasn't very particular in Quebec. The VAST majority of our EM doctors are GPs with an R3 (and I'd say more GPs w/o an R3 than R5s) but the provincial government is pushing for GPs to have a mandatory minimal amount of patients they follow so for new doctors, it would be very hard to focus completely on practicing EM. When it comes to EM 5-year residencies, we unfortunately all know what the match rates are and as such, I'm not comfortable with the idea of not having much control on which specialty I end up in (if I go unmatched).

Thanks for the opinion!

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On June 15, 2017 at 11:10 AM, Caliver said:

consider ENT, Uro. Good mix of clinics and ORs. 

May have ungodly hours in residency (depends on your institution) but your life tends to get significantly better as a staff (except if you subspecialize in surg onc). 

If you are Surg onc, you'll probably be in an academic center. That means besides the long ORs, you have minions to rounds on your patients (so you barely have to see them and never have to do anything like post op care) and you hardly have to operate if you don't want to (that's what the fellow is for). Downside is you need to research and publish. Depending on how involved you want to be, it can be pretty slack on the clinical side. 

 

Onc if you decide to be involved involved or aren't in an academic center can be very busy. 

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On 2017-06-14 at 8:07 AM, Snowmen said:

My school has a 2 week observation period where we rotate through many specialties in first year. I spent 2 days in IM and I honestly couldn't stand it as you spend most pretty much no time with patients and the work is very slow paced. I spent a day in intensive care and that was already more hands on and active so that's something I definitely could see myself doing. I like problem solving and the likes but the pace in IM is too slow for me whereas it is much quicker in anesthesia (when you need to problem solve) and anesthesia can lead to intensive care. What worries me about physiatry is that despite covering my MSK interest, it doesn't seem that far from IM in terms of practice style.

I spent half a day in radiology and that was already better. As you can guess from my interest in surgery, I love anatomy and therefore, despite still being reading in a way, radiology seems way more interesting to me because of the huge anatomy component. On top of that, you can do IR for a day or two every week and do procedures that, to me, look very interesting.

As you mentioned, surgery would obviously fit the bill of fast pace and procedures. I've gone to the OR a few time already and loved it but couldn't bring myself around the fact that exactly 100% of the surgery resident I've seen looked miserable. Add the fact that I'm an actively competing road cyclist and that maintaining decent shape would require 10-12 hours of training per week and the surgery schedule becomes a big problem. I want to do procedures but I'm not willing to waste my best years (24-29) being stuck in the hospital 80-100 hours/week (even though all residency obviously are demanding).

Thanks for all the opinions so far, that is very appreciated! :)

I get that you don't like internal but let me know how slow you think the pace is when you've done your CTU/MTU rotation. Haha. 

Shadowing does not equal real life. Just wait till you have like 3 consults lined up in emerg (just for you, the senior is probably triaging about 10) and your getting paged for a chest pain and a GI bleed upstairs. Super chill. 

It's not for everyone. It definitely wasn't for me. But I wouldn't write off the procedural IM specialties based on two days of shadowing.

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3 hours ago, amichel said:

I get that you don't like internal but let me know how slow you think the pace is when you've done your CTU/MTU rotation. Haha. 

Shadowing does not equal real life. Just wait till you have like 3 consults lined up in emerg (just for you, the senior is probably triaging about 10) and your getting paged for a chest pain and a GI bleed upstairs. Super chill. 

It's not for everyone. It definitely wasn't for me. But I wouldn't write off the procedural IM specialties based on two days of shadowing.

I agree with this. 

As a pre-clerkship med student, you have little responsibility and no clinical experience so many things might seem slow to you. 

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On 6/12/2017 at 6:13 PM, Snowmen said:

Hi,

I started medical school after leaving a PT BSc and was almost dead set on orthopedic surgery which would still be my dream specialty if it wasn't for two realisations I made: 1) I'd like to have a life 2) I'd like to have a job. Because of those, I figured I should pursue another specialty.

As my interest for surgery suggests, I'm seeking a specialty that's procedure-heavy and decent when it comes to lifestyle. It doesn't have to be the cushiest but hopefully easier that surgery. The pay does matter but that's not make or break for me. So far, I've narrowed it down to a few that could fulfill what I'm looking for:

Anesthesiology

Pros: Lots of procedures, very good remuneration, good lifestyle from what I understand, possibility to do lots of different things like critical care, pain clinics, etc., heard that residency isn't too bad outside of call

Cons: Reasonably competitive in CARMS (could be a problem since my school is grade based and so far my GPA is slightly above average but by no means extraordinary, not sure how anglophone schools treat GPAs from french schools)

Radiology

Pros: Possibility to go into IR and do a ton of extremly interesting procedures, heard that residency isn't too bad outside of call, seems interesting to me even if I don't end up doing IR

Cons: See anesthesiology regarding CARMS, IR is as hectic if not more than surgery

Physiatry

Pros: By far the best lifestyle of those three, possibility to do lots of procedures like infiltrations or nerve blocks, lots of subspecialties, fantastic job market in Quebec and that's not gonna change with the aging population

Cons: Remuneration is not that good, not sure why but I'm stuck with the idea that it's boring, might regret doing MSK but not going for orthopedics

Some other questions I have:

- What are some of the procedures you can do in each of these specialties?

- Any other specialties you can think of (ideally outside of IM subspecialties since I can't stand IM from the little exposure I've had so far).

So that's about it. If someone could enlighten me and share their thoughts about the specialties, I'd be very happy to hear from you! :)

I've done my orthopedics rotation and the job market is improving. Avoiding ortho because of some bad news right now isn't smart because you will be looking for a job at least 10 years from now and you won't know the job market then. Secondly, ortho has good lifestyle as staff. I know staff who finish their ORs and clinics by 12:30pm. Ortho ORs usually finish by 3 and unless you are on call you are done. Orthos work an average of 51 hrs in Canada versus 60 for Cardiologists. 

 

Explore Ortho more. 

 

Regarding IM, the only requirement for me I believe is that you like learning. If you are the kind of person that is fascinated by the details you are learning in pre-clerkship, perhaps slightly more so than your peers, IM is for you. If you are someone who just wants to get this medicine stuff over with and start working then you probably won't like the 500th lecture you get in IM about something you probably won't see in your practice. 

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4 hours ago, Edict said:

I've done my orthopedics rotation and the job market is improving. Avoiding ortho because of some bad news right now isn't smart because you will be looking for a job at least 10 years from now and you won't know the job market then. Secondly, ortho has good lifestyle as staff. I know staff who finish their ORs and clinics by 12:30pm. Ortho ORs usually finish by 3 and unless you are on call you are done. Orthos work an average of 51 hrs in Canada versus 60 for Cardiologists. 

 

Explore Ortho more. 

 

Regarding IM, the only requirement for me I believe is that you like learning. If you are the kind of person that is fascinated by the details you are learning in pre-clerkship, perhaps slightly more so than your peers, IM is for you. If you are someone who just wants to get this medicine stuff over with and start working then you probably won't like the 500th lecture you get in IM about something you probably won't see in your practice. 

That's 51 hrs excluding call, on average. The typical full time ortho is easily doing 60+ hrs per week including call on average, perhaps more. Cardiology is a very busy IM specialty, so not a great comparison for hours. 

While I too have heard mixed things regarding jobs in ortho, the fact of the matter is that the current "requirement" is essentially two fellowships and that won't change. Patients rightly expect an expert in a specific area for their surgery, and why would hospitals slack off on the training qualifications of their applicants just because somewhat more jobs become available? Moreover, to get an academic spot likely there will need to be some sort of added research training on top of residency/fellowship. Lastly, while jobs may become more available, they will never get to the point where an orthopaedic surgeon can pick a location and open up shop the way some other specialties can - there may be jobs in ortho one day, but you won't choose where. 

All that to say, sure maybe there will be more jobs in the future for ortho, but let's not sugar coat this. Ortho is one of the worst in terms of job availability right now, so even with new openings it is still going to be a tight market. It absolutely comes with extra years of training, a guaranteed busy work schedule in residency, busy as a staff in most cases (though certainly better than residency), and pretty much no one would call it a lifestyle specialty in terms of flexibility and hours. These are not all bad things - it's a cool specialty, and if it's what OP loves more than anything they should consider it. But doing it just because you like it is naive. It's a job, and so other factors concerning training and life should rightly be considered and put on balance.  

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4 hours ago, ZBL said:

That's 51 hrs excluding call, on average. The typical full time ortho is easily doing 60+ hrs per week including call on average, perhaps more. Cardiology is a very busy IM specialty, so not a great comparison for hours. 

While I too have heard mixed things regarding jobs in ortho, the fact of the matter is that the current "requirement" is essentially two fellowships and that won't change. Patients rightly expect an expert in a specific area for their surgery, and why would hospitals slack off on the training qualifications of their applicants just because somewhat more jobs become available? Moreover, to get an academic spot likely there will need to be some sort of added research training on top of residency/fellowship. Lastly, while jobs may become more available, they will never get to the point where an orthopaedic surgeon can pick a location and open up shop the way some other specialties can - there may be jobs in ortho one day, but you won't choose where. 

All that to say, sure maybe there will be more jobs in the future for ortho, but let's not sugar coat this. Ortho is one of the worst in terms of job availability right now, so even with new openings it is still going to be a tight market. It absolutely comes with extra years of training, a guaranteed busy work schedule in residency, busy as a staff in most cases (though certainly better than residency), and pretty much no one would call it a lifestyle specialty in terms of flexibility and hours. These are not all bad things - it's a cool specialty, and if it's what OP loves more than anything they should consider it. But doing it just because you like it is naive. It's a job, and so other factors concerning training and life should rightly be considered and put on balance.  

All the numbers I gave were excluding call so if you add call all numbers will go up. I think 2 fellowships is the new norm for a lot of specialties, not just ortho. The important thing is it is still doable and if you are interested in ortho it is not right to avoid it so early on in medical school just because you don't think there will be jobs in 10 years. There is no way anyone can tell you whether or not there will be jobs in 10 years. The graduating resident I spoke to already has job offers and is pursuing fellowship in order to be subspecialty trained or get a better job.  

 

 

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On June 18, 2017 at 9:26 PM, Edict said:

All the numbers I gave were excluding call so if you add call all numbers will go up. I think 2 fellowships is the new norm for a lot of specialties, not just ortho. The important thing is it is still doable and if you are interested in ortho it is not right to avoid it so early on in medical school just because you don't think there will be jobs in 10 years. There is no way anyone can tell you whether or not there will be jobs in 10 years. The graduating resident I spoke to already has job offers and is pursuing fellowship in order to be subspecialty trained or get a better job.  

 

 

What other specialties are 2 fellowship norm for a job now? Cardiology? I can't think of another surgical specialty.  I'm also talking about landing any reasonable job, not landing a staff job at U of T. 

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On 6/19/2017 at 10:21 PM, NLengr said:

What other specialties are 2 fellowship norm for a job now? Cardiology? I can't think of another surgical specialty.  I'm also talking about landing any reasonable job, not landing a staff job at U of T. 

What I mean by 2 fellowships is also including the one year fellowships that are becoming two year fellowships. 

I think Cardio is one of them where fellowship is getting longer. Cardio itself is 6 years and EP is now 2 years, Intervention is now essentially 2 years, some are doing ICU after Cardio and now there is Structural which is a fellowship after Interventional for those interested in TAVI/ASD/Mitraclip. Cardiac Surgery is definitely one of them, also in Gen Surg, 2 year Gen Sx fellowships are becoming more common. I know in Ortho it isn't uncommon to do 2 fellowships or more. I'm not really familiar with other surgical specialties, but it just wouldn't surprise me at all if I heard now someone did a year of one fellowship and then a year of another. 

 

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29 minutes ago, Edict said:

What I mean by 2 fellowships is also including the one year fellowships that are becoming two year fellowships. 

I think Cardio is one of them where fellowship is getting longer. Cardio itself is 6 years and EP is now 2 years, Intervention is now essentially 2 years, some are doing ICU after Cardio and now there is Structural which is a fellowship after Interventional for those interested in TAVI/ASD/Mitraclip. Cardiac Surgery is definitely one of them, also in Gen Surg, 2 year Gen Sx fellowships are becoming more common. I know in Ortho it isn't uncommon to do 2 fellowships or more. I'm not really familiar with other surgical specialties, but it just wouldn't surprise me at all if I heard now someone did a year of one fellowship and then a year of another. 

 

Yeah I completel forgot about cardiac surg and neurosurg. To be honest, they're so bad I think I just assume nobody will ever get a job, no matter how many fellowships. 

I heard the gen surg grads at my former residency center had about 50% of them get community jobs without fellowships. A big chunk of the fellowship people were trying to get into academic centers. I think the academic centers are preferring the 2 year fellowships now because you get a huge chunk (~1 year) of research experience. Kind of how more and more are asking for a masters. But in gen surg I think there are still a reasonable amount of jobs you can land without any fellowship. The 1 year fellowship seems to be more for the people going into the community who want/need some clinical expertise but don't really need the research training. 

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You seem to lack experience to choose what you like and it is unfortunately normal considering your lack of exposure to make informed choices. Many of the points you mention that interest you in those specialties are not really good representations of the everyday job.

You should not go into radiology if it is mainly the procedures that interest you. You have to be interested in the diagnostic portion at least as much as it is the essential part of the work, the fundamental aspect of this specialty. Otherwise you're going to hate your career. It's like wanting to go into general surgery mainly because the whipples procedure are interesting.

If you find that IM has a slow pace, wait to see the physiatry. Physiatry is the third line of back pain, fibromyalgia, CRPS, stroke and amputees. You need to enjoy multidisciplinary meetings, speak for a long time about a single patient, plan rehabilitation, deal with difficult recoveries, all with a big psychosocial side. The MSK is just one facet. The procedures are simple and can be mostly done by an inexperienced clerk ... Nowadays, the rest is done in radiology.

I think it's a mistake to choose a career by saying to yourself that you need to work with your hands. It's like going to the hardware store, buying a drill to have a drill, because you need tools. It's not a drill you want, it's a hole. Same thing in medicine, your hands are the tools to accomplish what you like in a speciality: restoring an MSK function in ortho, resecting intestinal cancer while preserving the GI function in gen surg, a mixture of repairing appearance and function throughout the entire surface of the body (plastics), take control of the cardiovascular system through intubation and ventilatory parameters (anesth) ... etc ... If you want to work with your hands but none of this interest you, you are making a mistake to go into a "procedural-heavy" speciality.

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Its important also to know that procedural heavy specialty does not mean you go in and fix something and leave. If you are truly purely procedure only then you should consider Anesthesia or Interventional Radiology. These people do procedures and go home and never have to think about the consequences. 

A lot of people mistake liking procedures for liking good outcomes:

If you are someone who likes shorter procedures/surgeries with good outcomes and short hospital stay, consider Orthopedics, Interventional Cardiology, Cardiac EP, GI, Urology, OB/GYN, ENT, Ophtho, Breast Surgery, Plastic Surgery. 

If you like shorter procedures with questionable or even poor outcomes: ICU

If you like big surgeries that have good outcomes: Cardiac Surgery, Bariatric Surgery, Colorectal Surgery, Transplant Surgery (good considering the circumstances (Uro, HPB, Cardiac, Thoracic)) 

Big surgeries with questionable or even poor outcomes: HPB Surgery, Thoracic Surgery, Neurosurgery, Trauma Surgery

 

Also, the reality is that procedural heavy specialties almost NEVER have good hours during residency and many don't have good hours as staff. If I were you, I would explore specialties first and really think about what kind of lifestyle you want. Most of the very few doctors who actually do procedural heavy specialties, are married to their jobs. 

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