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Hey guys,

I've been looking into specialties that tend to see healthy patients with minimal acuity, and ones that focus on disease management and prevention aspect of it, with minimal physical procedures (other than lab based specialties like microbiology, pathology and radiology)

I made a short list of specialties that kind of fit into these, but are there anything else?

- Family Medicine
- Physiatry
- Psychiatry
- Pediatrics 
- Molecular Genetics
- Rheumatology, Allergy/Immunology
- Geriatrics
- Hematology?

Eliminate: Anesthesiology, General Internal Medicine, Respirology, Cardiology, Emergency Medicine, any surgical specialty  

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32 minutes ago, brady23 said:

Hey guys,

I've been looking into specialties that tend to see healthy patients with minimal acuity, and ones that focus on disease management and prevention aspect of it, with minimal physical procedures (other than lab based specialties like microbiology, pathology and radiology)

I made a short list of specialties that kind of fit into these, but are there anything else?

- Family Medicine
- Physiatry
- Psychiatry
- Pediatrics 
- Molecular Genetics
- Rheumatology, Allergy/Immunology
- Geriatrics
- Hematology?

Eliminate: Anesthesiology, General Internal Medicine, Respirology, Cardiology, Emergency Medicine, any surgical specialty  

Endocrinology 

community medicine

maternal fetal medicine 

 

 

 

 

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11 hours ago, brady23 said:

Hey guys,

I've been looking into specialties that tend to see healthy patients with minimal acuity, and ones that focus on disease management and prevention aspect of it, with minimal physical procedures (other than lab based specialties like microbiology, pathology and radiology)

I made a short list of specialties that kind of fit into these, but are there anything else?

- Family Medicine
- Physiatry
- Psychiatry
- Pediatrics 
- Molecular Genetics
- Rheumatology, Allergy/Immunology
- Geriatrics
- Hematology?

Eliminate: Anesthesiology, General Internal Medicine, Respirology, Cardiology, Emergency Medicine, any surgical specialty  

                                Healthy Patients        Min Acuity        Min Procedures     Comment

Family medicine                X                          X                           X                 Big range. Only place you will see completely healthy pts.

Physiatry                           O                          X                 *rehab type stuff    Relatively physically active specialty, sees patients needing rehab.

Psychiatry                         O                         X                           X              If you're seeing a psych, you're probably sick, but possibly not physically

[Gen] Pediatrics                O                      varies                       X                 Big range, usually not healthy pts. Can be high acuity in hosptialists.

Molecular Genetics           O                          X                          X             You're not healthy if you're seeing a geneticist. But no genetic emergencies

Rheum/allergy              yes for allergy            X                          X               Some healhy pts for allergists, but they do minor procedures

Geriatrics                          O                          X                           X                  Never going to see a healthy person ever

Hematology                       O                         X                            O              Heme pts can be very sick. Some do bone marrow biopsies etc

endocrine                       mix                         mix                          X               T1DM checkups can be realtively healthy, but also manage DKA etc.

maternal fetal med            O                        O                            O             A surgeon expected to do crash c-sections. Not what you're looking for

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6 hours ago, bearded frog said:

                                Healthy Patients        Min Acuity        Min Procedures     Comment

Family medicine                X                          X                           X                 Big range. Only place you will see completely healthy pts.

Physiatry                           O                          X                 *rehab type stuff    Relatively physically active specialty, sees patients needing rehab.

Psychiatry                         O                         X                           X              If you're seeing a psych, you're probably sick, but possibly not physically

[Gen] Pediatrics                O                      varies                       X                 Big range, usually not healthy pts. Can be high acuity in hosptialists.

Molecular Genetics           O                          X                          X             You're not healthy if you're seeing a geneticist. But no genetic emergencies

Rheum/allergy              yes for allergy            X                          X               Some healhy pts for allergists, but they do minor procedures

Geriatrics                          O                          X                           X                  Never going to see a healthy person ever

Hematology                       O                         X                            O              Heme pts can be very sick. Some do bone marrow biopsies etc

endocrine                       mix                         mix                          X               T1DM checkups can be realtively healthy, but also manage DKA etc.

maternal fetal med            O                        O                            O             A surgeon expected to do crash c-sections. Not what you're looking for

Endocrine only manages DKA in hospital

 

hahahahahahah

 

Do you even know what Maternal Fetal medicine is ??? Crash C sections? Surgeons? 

What are you talking about ?

 

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3 hours ago, Aconitase said:

Endocrine only manages DKA in hospital

 

hahahahahahah

 

Do you even know what Maternal Fetal medicine is ??? Crash C sections? Surgeons? 

What are you talking about ?

 

Ha, everyone is so grumpy lately :) Yeah I think there are minor things wrong though but the summary I think is a good overall start! Endocrine would manage a lot of hormone imbalance issues with diabetes rightfully put as the most common. 

I mean maternal fetal medicine isn't directed towards c section etc but you do have to be I thought an oby/gen to take the required fellowship in maternal fetal medicine in Canada. If so they would be trained to be a full oby/gen and it may be centre specific to whether you would have to do the oby part (as in call for instance) with the maternal fetal medicine (?).  So not a direct part of the the MFM job/fellowship but I think when you work at most places you don't get to throw all that out in the group you are working in (at least a number of centres). 

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18 hours ago, brady23 said:

Hey guys,

I've been looking into specialties that tend to see healthy patients with minimal acuity, and ones that focus on disease management and prevention aspect of it, with minimal physical procedures (other than lab based specialties like microbiology, pathology and radiology)

I made a short list of specialties that kind of fit into these, but are there anything else?

- Family Medicine
- Physiatry
- Psychiatry
- Pediatrics 
- Molecular Genetics
- Rheumatology, Allergy/Immunology
- Geriatrics
- Hematology?

Family med can be quite variable, but it is possible to have an office-based practice that stays away from acuity. 

Physiatrists can actually be involved in procedures, e.g. interventional pain medicine. But I don't know a lot about it on a day-to-day basis. 

You will see lots of acutely sick patients (psychosis, substance-related, etc.) in psych, but I imagine there's fairly wide ability to structure your practice as you wish after residency. Only real procedure is ECT ($$$$). 

General outpatient peds will see mostly healthy kids with nonspecific complaints, e.g. concerns about development or abdominal pain. 

Medical genetics is a tiny field that's a subspecialty of peds most of the time. 

Rheumatologists occasionally do joint aspirations. They will see sick people, but not always in the more acute phases. Allergists do skin tests and such but it's the most non-acute of the most non-acute. 

Geriatricians will see lots of cognitive complaints. Don't know that they have a very healthy population, but it has a very relaxed pace. 

Hematologists do marrows. Any that do malignant heme (most of them) deal with extremely sick patients. 

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2 hours ago, Aconitase said:

Endocrine only manages DKA in hospital

 

hahahahahahah

 

Do you even know what Maternal Fetal medicine is ??? Crash C sections? Surgeons? 

What are you talking about ?

 

 

2 hours ago, rmorelan said:

Ha, everyone is so grumpy lately :) Yeah I think there are minor things wrong though but the summary I think is a good overall start! Endocrine would manage a lot of hormone imbalance issues with diabetes rightfully put as the most common. 

I mean maternal fetal medicine isn't directed towards c section etc but you do have to be I thought an oby/gen to take the required fellowship in maternal fetal medicine in Canada. If so they would be trained to be a full oby/gen and it may be centre specific to whether you would have to do the oby part (as in call for instance) with the maternal fetal medicine (?).  So not a direct part of the the MFM job/fellowship but I think when you work at most places you don't get to through all that out in the group you are working in (at least a number of centres). 


Agree with rmorelan here. No need to be snarky, we're all just here to better understand medicine.

Maternal Fetal Medicine is a subspecialty of OB/GYN often involving high-risk pregnancies. So I don't see under any circumstance (including private practice in the states) where a OB/GYN with MFM fellowship wouldn't do call as these mothers need to be follow-up til labour/birth.

A field in OB/GYN that may not take call is REI, which is Reproductive Endocrinology & Infertility. I'm not certain, but I think OBS/GYN who specialize in REI could find a niche work environment where they don't take call (possibly not a thing in Canada).

Dermatology should be on that list.

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14 minutes ago, BoopityBoop said:

 


Agree with rmorelan here. No need to be snarky, we're all just here to better understand medicine.

Maternal Fetal Medicine is a subspecialty of OB/GYN often involving high-risk pregnancies. So I don't see under any circumstance (including private practice in the states) where a OB/GYN with MFM fellowship wouldn't do call as these mothers need to be follow-up til labour/birth.

A field in OB/GYN that may not take call is REI, which is Reproductive Endocrinology & Infertility. I'm not certain, but I think OBS/GYN who specialize in REI could find a niche work environment where they don't take call (possibly not a thing in Canada).

Dermatology should be on that list.

No it shouldn't. They said no procedures, and derm is about as procedural as it gets without being full blown surgical. 

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3 hours ago, rmorelan said:

I mean maternal fetal medicine isn't directed towards c section etc but you do have to be I thought an oby/gen to take the required fellowship in maternal fetal medicine in Canada. If so they would be trained to be a full oby/gen and it may be centre specific to whether you would have to do the oby part (as in call for instance) with the maternal fetal medicine (?).  So not a direct part of the the MFM job/fellowship but I think when you work at most places you don't get to throw all that out in the group you are working in (at least a number of centres). 

MFM is a subspecialty of obstetrics and I've interacted with many an MFM fellow on the L&D unit. They do plenty of OB call - and certainly in training for the ol' FRCSC. 

Obstetrical Medicine, though, is more or less a subspecialty of GIM. It's still mostly a healthy population; the bread and butter is about adjusting post-partum labetolol for a couple weeks. It does mean having an outpatient practice devoted to women-of-childbearing-age to the exclusion of everyone else. No one who specializes in OB medicine escapes from GIM call, though. 

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21 hours ago, brady23 said:

Hey guys,

I've been looking into specialties that tend to see healthy patients with minimal acuity, and ones that focus on disease management and prevention aspect of it, with minimal physical procedures (other than lab based specialties like microbiology, pathology and radiology)

I made a short list of specialties that kind of fit into these, but are there anything else?

- Family Medicine
- Physiatry
- Psychiatry
- Pediatrics 
- Molecular Genetics
- Rheumatology, Allergy/Immunology
- Geriatrics
- Hematology?

Eliminate: Anesthesiology, General Internal Medicine, Respirology, Cardiology, Emergency Medicine, any surgical specialty  

plus you won't want radiology on the list anyway as we do a ton of procedures - often that is 25% of the job or more in community radiology. 

we aren't lab based - that is probably just a grouping error :)

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17 minutes ago, A-Stark said:

MFM is a subspecialty of obstetrics and I've interacted with many an MFM fellow on the L&D unit. They do plenty of OB call - and certainly in training for the ol' FRCSC. 

Obstetrical Medicine, though, is more or less a subspecialty of GIM. It's still mostly a healthy population; the bread and butter is about adjusting post-partum labetolol for a couple weeks. It does mean having an outpatient practice devoted to women-of-childbearing-age to the exclusion of everyone else. No one who specializes in OB medicine escapes from GIM call, though. 

thanks for clearing that up - the MFM I worked with on my oby/gen US rotations were all clearly preping for standard oby call. 

you probably know more than I the overall points between MFM, OB medicine and pediatrics. Just looking at that list suggests there would be overlap/intersection(?)

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45 minutes ago, ZBL said:

No it shouldn't. They said no procedures, and derm is about as procedural as it gets without being full blown surgical. 

True! I wonder if OP would consider simply procedures (I mean derm ones aren't that hard) to be included ultimately. This is a good thought exercise.

5 minutes ago, W0lfgang said:

Consider neurology. You might have to do the odd LP or stroke call, but could be minimized depending on where you practice or your subspecialty.

sure I would agree with that as long as you aren't at a busy stroke centre. Ha, the very definition of acute :) There are 3 going on right now as I type.

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2 minutes ago, rmorelan said:

True! I wonder if OP would consider simply procedures (I mean derm ones aren't that hard) to be included ultimately. This is a good thought exercise.

sure I would agree with that as long as you aren't at a busy stroke centre. Ha, the very definition of acute :) There are 3 going on right now as I type.

Indeed. I got more a sense of OP desiring a "clean" environment, and while derm procedures are no whipples surgery, they can be messy/bloody - lots of excisions, things pussing and oozing or necrotic, and mohs can be quite extensive

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On 3/11/2018 at 5:21 PM, Aconitase said:

Endocrine only manages DKA in hospital

 

hahahahahahah

 

Do you even know what Maternal Fetal medicine is ??? Crash C sections? Surgeons? 

What are you talking about ?

 

I don't think you know what you're talking about... I worked with MFM OBs during my OB rotations, they went to deliveries and actively managed complex maternal cases, including call, and if one of their patients need a stat c-section they did it. And at my centre DKAs are admitted under the endocrinologist on call so I'm not sure what you mean? I didn't mean to suggest that IM didn't manage them either.

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16 hours ago, bearded frog said:

I don't think you know what you're talking about... I worked with MFM OBs during my OB rotations, they went to deliveries and actively managed complex maternal cases, including call, and if one of their patients need a stat c-section they did it. And at my centre DKAs are admitted under the endocrinologist on call so I'm not sure what you mean? I didn't mean to suggest that IM didn't manage them either.

My mistake. I meant more obstetrical medicine where you adjust med doses. MFM in its own is not terrible Will involve OB call. 

 

In in most places DKA is admitted to a step down or ICU under GIM it ICU

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Obstetrical medicine is a subspecialty of GIM. No one does it exclusively. 

DKAs can go to the floor provided you can get the nurses to do frequent glucometer checks. But really it will resolve in hours if properly treated so some patients barely need to leave emerg! 

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4 hours ago, A-Stark said:

Obstetrical medicine is a subspecialty of GIM. No one does it exclusively. 

DKAs can go to the floor provided you can get the nurses to do frequent glucometer checks. But really it will resolve in hours if properly treated so some patients barely need to leave emerg! 

A lot of floors do not allow IV insulin for safety reasons to be run on the floor. It will depend on the institution. And many do not leave ER you are correct but they often are managed by GIM or ICU with perhaps an endo consult. 

 

Some people do obsterical medicine as a career. I did an elective in Toronto

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On 3/15/2018 at 7:16 PM, A-Stark said:

And I have no idea why endo would ever have to be involved with DKA. 

I've never seen an endocrinologist manage DKA on the ward, but sometimes the ER doc (usually from a smaller peripheral site, where they might see 1 DKA per year) will call the on-call endocrinologist for management advice. Then they are usually redirected to the GIM on call :P

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