Category Archive: Why did you choose….?

Spotlight Interviews: What is a Transitional Year Residency?

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Anesthesia, Choosing a Specialty, Dermatology, How to match in....?, Neurology, Ophthalmology, Radiology, Residency, The Match, Why did you choose....?

September 11, 2012

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sleeping resident Spotlight Interviews: What is a Transitional Year Residency?

 

A Transitional Year Resident's Perspective: An interview with a transitional year resident from the Ann Arbor, Michigan.

Part of an interview series entitled, "Specialty Spotlights", which asks medical students' most burning questions to physicians of every specialty. See what doctors from every specialty had to say about why they chose their specialtyand how to match in their residency.

 

  • What is a transitional year residency?

Transitional Year (TY) residencies might be the least well known residency option after medical school. The TY is a one year residency with a general focus which prepares recent graduates for advanced residencies. To understand where a TY fits in, you must understand that there are a number of residency programs that do not start specialty training until the 2nd year after medical school graduation (i.e. PGY2). These specialties include anesthesia, dermatology, neurology, physical medicine and rehabilitation, radiology, radiation oncology, and ophthalmology.

Each of these residencies begin their specialty training after a resident's intern year. Many of these residency programs will combine the intern year (PGY1) with the advanced specialty training. In these cases, the resident will remain in the same residency throughout their training and there is no need to complete a transition year residency. However, there are programs in each of these specialties that do not start training their residents until the second year after medical school (PGY2). These programs require their residents to complete an approved intern year prior to beginning specialty training. Approved intern years include a year of preliminary medicine, preliminary surgery, preliminary pediatrics, or a transitional year residency.

 

  • How is a transitional year residency different from other intern years?

The goals of training are basically the same among all intern years; we all learn hospital based patient care. Surgical interns take care of patients before and after surgery in the hospital, medicine interns take care of medical patients in the hospital, pediatric interns take care of kids in the hospital. A transitional year resident will take care of all of the above. The transitional year aims to be a broad hospital-based training. TY residents will spend various months working on medicine, surgical, OB, pediatric, outpatient, ED, ICU, and elective rotations. The great asset of a TY is that it provides more flexibility, allowing residents to focus on their interests. I am interested in research and was able to complete two months of intense research during my intern year: something no one from an internal medicine, surgery, or any other residency could say.

 

  • Are Transitional Year Residencies easy?

Not all TYs are made equally. It is a well known fact that there are some pretty cush TY residencies out there. However, there are also some very difficult TYs. To illustrate this fact, last year I interviewed at a number of TY residencies of varying difficulties. The easiest one had 4 required inpatient months, one outpatient month, one ED month, and 6 electives. Sign out during inpatient months was 3pm. When you were in the ICU you covered 2-3 patients, and you were NEVER on call the entire year. In contrast, I interviewed at a big hospital TY where there were two MICU months where you covered 15 patients, 6 required inpatient medicine months, 2 surgery months, a busy ED month, terrible call, and three 'electives' which were all time consuming. In general, however, the answer to this question is yes. Transitional years are FAR easier than prelim surg residencies and quite a bit easier than prelim medicine residencies as well.

 

  • Is the training as good at a Transitional Year Residency?

Absolutely, if you choose the right place. Many months this year I have more free time than I did in medical school. I have found that with the free time I am actually reading and studying a ton. I think that you MUST take call to learn how to be a doctor during your intern year. I am not sure how you can become a 'well trained' doctor if you never take call during your intern year. Being on call at night is when you really have to make decisions and you really learn a ton. You don't need 11 months of inpatient work to become a great radiologist or a great ophthalmologist. However, 6 solid months of medicine/surgery will certainly prepare you for your next level of training. Then you can spend the other half of the year becoming great at something else: research, pediatrics, surgery, golf, sleeping, etc etc

 

  • Describe a typical transitional year schedule?

Everyone must do: 1 month in the ICU, 1 month ED, 1 month outpatient, 2 months general medicine. I believe the rest is up to the residency program. Most programs end up giving 3-5 months of electives.

 

  • What are the potential downsides of a Transitional Year?

Not many! More free time, less stress, more fun…what's not to like. I guess one downside is that it closes some doors if you choose to switch specialties. For example, if you were doing a preliminary medicine year at an academic center and decided you wanted to do medicine instead of anesthesia, the switch would be easier. After completing a TY year you can only go into the specialties I listed above.

 

  • How competitive is the Transitional Year match?

It is actually very competitive. There are not many spots, and they are all coveted because they represent less work, more free time, more electives, and a much easier year. Also, imagine all the applicants trying to get spots: future radiologists, ophthalmologists, radiation oncologists, dermatologists. This is not a list of ordinary applicants. Matching into a TY is about as hard as matching into radiology or ophthalmology.

 

  • What are residencies looking for in a Transitional Year applicant?

I asked my TY program directer this exact question and this was his response: "We know we will only have you for one year. However, during that year the TY class will take care of about 50% of all the patients in this hospital. So, it is in the hospitals best interest to have someone who 1- will work hard without being asked, and 2- will maintain the great patient care that we have at the hospital." I think those two things are exactly what all programs want. I think item #2 may touch on competency a little bit, but is mostly referring to your interpersonal skills.

 

  • What should students look for in a Transitional Year residency?

Whatever you want to look for in a TY year. That sounds cliche, but as I said above, not all TYs are made equally. Do you want a chill year at the risk of missing out on training? You can find that. Do you want to do pediatrics as well as medicine and surgery? You can find that.

 

  • Is there anything you wish you knew before application season?

I interviewed at a few places that had both TY years as well as preliminary medicine years but the curriculum was exactly the same. In other words, if you match into the preliminary medicine year, you still have the flexibility that the TY residents at the same program have. All of these programs will let you apply to both the TY and the prelim med year after your single interview. These are great programs to find because even though there is no difference at all in the curriculum, the preliminary medicine years are a bit easier to get into.

 

  • What other advice to you have for students applying to a Transitional Year?

Good luck, intern year is exhilarating, fantastically rewarding, difficult, and very very short. Enjoy it. Read The House of God Spotlight Interviews: What is a Transitional Year Residency? (amazon link), there is no better time than intern year. Also, watch the first season of Scrubs Spotlight Interviews: What is a Transitional Year Residency? where the characters are interns…it is incredibly realistic!

 

 

Editor's Note: For more help choosing a specialty in medicine, I highly recommend The Ultimate Guide to Choosing a Medical Specialty Spotlight Interviews: What is a Transitional Year Residency?. If you are interviewing or working on your application for orthopedics or another specialty, check out First Aid for the Match and The Successful Match: 200 Rules to Succeed in the Residency Match.

 

 






 

 

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Spotlight Interview: An Orthopaedic Surgeon’s Job Description

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Choosing a Specialty, How to match in....?, Orthopedic Surgery, Residency, The Match, Why did you choose....?

August 18, 2012

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Orthopedic Surgery Spotlight Interview: An Orthopaedic Surgeons Job Description

 

An Orthopedic Surgery Resident's Perspective: An interview with an orthopedics resident from the West Coast

Part of an interview series entitled, "Specialty Spotlights", which asks medical students' most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • What attracted you to Orthopedic Surgery?

I feel like you can learn a lot about a specialty based on what you see in the attending physicians of that specialty. The orthopedic attendings, for the most part, seemed happy. There are many sub-specialties in Ortho and was interested in nearly all of them. The patients' prognoses in many cases were very good. Patient’s lives were improved dramatically by Orthopedic intervention.

 

 

  • Describe an Orthopedic Surgeon's typical work day?

Long. Orthopedic Surgery is no place for individuals looking for a structured 8 to 5 job. Attendings often work harder than residents. First and foremost, the patient comes first and your day ends when the work is done.

 

ortho resident Spotlight Interview: An Orthopaedic Surgeons Job Description

  • What type of lifestyle can a an Orthopedic Surgeon expect?  

It's not dermatology. Call and nights vary between sub-specialties, but generally if you are asking this question, Orthopedic Surgery may not be the right choice for you.

 

  • What is the average salary of an Orthopedic Surgeon?

Also varies from specialty to specialty. Generally speaking Orthopedic Surgeons are some of the best compensated surgical specialists, but that should only be a perk. Don’t go into Orthopedic Surgery for the money, times are changing.

 

  • What is the job market like for Orthopedic Surgery?

The market varies amongst subspecialties. Hand Surgery and Sports Medicine are amongst the most competitive now, but are also rather saturated. Generally speaking, our aging population bodes well for our job security for the next couple of decades at least.

 

  • What can you tell us about Orthopedic Surgery sub-specialties?

Residencies currently range from 5-6 years with 1 year fellowships available in: Shoulder, Hand, Spine, Tumor, Joints, Sports Medicine, Pediatrics, Trauma… About 85% of current residency graduates are going onto Fellowship training.

 

  • What are the potential downsides of Orthopedic Surgery?

Be prepared to work hard and not complain.

 

  • What else would you tell medical students who are considering Orthopedic Surgery?

With a good work ethic and the right motives, Orthopedic Surgery will offer a rewarding lifetime of challenge and service.

 
ortho cartoon Spotlight Interview: An Orthopaedic Surgeons Job Description

  • How competitive is the Orthopedic Surgery match?

Very, with the caveat that interpersonal and personality traits cannot emphasized enough.

 

  • What are residencies looking for in an Orthopedic Surgery applicant?

You will need to reach a certain threshold of competency/test scores (different programs weight each of these differently). The rest is studying and hard work. Away rotations are usually weighted pretty heavily and should be considered a month long job interview. Dress appropriately, prepare for cases/clinic, show up early, etc.

 

 

  • What should students look for in an Orthopedic Surgery residency?

I would want to feel fairly comfortable with the people you interact with. You will be spending a good chunk of your life with them. Also, ask them the appropriate, but difficult questions. I always appreciated programs that seemed to be up front and honest.

 

 

  • Do you have any advice about the residency application?

Spend plenty of time on your personal statement and have it proofread by several different people. Another thing that I found useful was to offer to draft letters for those you ask…chances are good they are probably busier than you are.

 

  • Is there anything you wish you knew before application season?

Give every day your best shot. Otherwise stop worrying. The rest takes care of itself. No amount of worry will do anything but shorten your life span.

 

  • What other advice to you have for students applying to Orthopedics?

Good luck! It is a stressful, but dynamic time in life.

 

Editor's Note: For more help choosing a specialty in medicine, I highly recommend The Ultimate Guide to Choosing a Medical Specialty Spotlight Interview: An Orthopaedic Surgeons Job Description.  If you are interviewing or working on your application for orthopedics or another specialty, check out First Aid for the Match and The Successful Match: 200 Rules to Succeed in the Residency Match.

 









 

 

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Spotlight Interview: Why Did You Choose Anesthesia? (Pittsburgh Resident)

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Anesthesia, Choosing a Specialty, Residency, Why did you choose....?

July 9, 2012

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anesthesia residency1 Spotlight Interview: Why Did You Choose Anesthesia? (Pittsburgh Resident)

 

An Anesthesia Resident's Perspective: From an interview with an anesthesia resident from the University of Pittsburgh Medical Center in Pittsburgh, Pennsylvania.

Part of an interview series entitled, "Specialty Spotlights", which asks medical students' most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • What attracted you to Anesthesia?

I was attracted to the intimate patient care, to a specialty that is procedurally oriented, and to a specialty that requires a working knowledge of physiology and pharmacology.  I saw a lot of energy in the fact that anesthesiologists need to have the ability to control all aspects of a patient's response to surgery in real time.

 

  • Describe an Anesthesiologist's typical work day?

This depends on the type of practice you will ultimately choose. Generally, anesthesiologists arrive early-ish (like 6:30-7am) and are usually done when all surgeries are finished for the day (this can range from 3pm- 6pm depending on working environment).  Weekends and nights are infrequent, but some call is generally taken at least early in your career.

 

  • What type of lifestyle can a Anesthesiologist expect?

The lifestyle is very good. Like I said, weekends and nights are usually free unless you need to take hospital call, which is infrequent at worst.  If you end up at a private practice at an outpatient surgery center you can expect to work from 7am until 5pm Monday thru Friday!

 

  • What is the average salary of a Anesthesiologist?

250k-450k per year.  Some jobs will start you as high as 400k if you will move to a 'less desirable' location.  Salaries are lower for big cities, just like all other specialties. More details at http://www.gaswork.com

 

  • What is the job market like for Anesthesiology?

Excellent.

 

  • What can you tell us about Anesthesiology Sub-specialties?

Most fellowships are another 1-2 years after residency. The most common fellowships are pain management, pediatrics, critical care medicine, and cardiovascular anesthesia.

 

  • What are the potential downsides of Anesthesiology that students should be aware of?

There is some concern over liability, but this is no different than Ortho, neurosurgery, ob/gyn, and many other specialties involved in surgery..  The concern that CRNA's will take all the work away is commonly overstated.

 

  • What else would you tell medical students who are considering Anesthesiology?

Work hard in all rotations, and especially on your anesthesia rotation.  Commonly an anesthesia rotation is one where you can go home at lunch and no one notices, but it pays huge dividends if you get noticed working "late" (like til 4pm).  Actively seek out procedural opportunities on all rotations.  Try to do related rotations like pulmonary consults and pain management. You definitely should complete an ICU rotation and you should do you best to excel at it.

 

Editor's Note: For more help choosing a specialty in medicine, I highly recommend The Ultimate Guide to Choosing a Medical Specialty Spotlight Interview: Why Did You Choose Anesthesia? (Pittsburgh Resident).

 




 

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Spotlight Interview: Why Did You Choose Anesthesia? (Emory Resident)

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Anesthesia, Choosing a Specialty, Why did you choose....?

June 4, 2012

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anesthesia residency Spotlight Interview: Why Did You Choose Anesthesia? (Emory Resident)

 

An Anesthesia Resident’s Perspective: From an interview with an anesthesia resident from the Emory University in Atlanta, Georgia.

Part of an interview series entitled, “Specialty Spotlights“, which asks medical students’ most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • What attracted you to Anesthesia?

A couple of things stand out to me.  First and foremost, I was attracted to its pace & acuity.  I learned pretty quickly in medical school that I was not destined to manage a wide variety of chronic problems.  I have always been the type of person that prefers high-pressure situations and quick decision-making.  Secondly, I felt I had a lot in common with the other anesthesiologists I met.  There is most certainly a “personality type” that seems to gravitate toward the field – usually personable, outgoing but quietly knowledgable physicians.  Most importantly, they are the type of doctors that underscore doing a great job by staying out of the limelight.

 

  • Describe an Anesthesiologist’s typical work day?

A typical day for a general OR anesthesiologist involves the following – Arriving at the hospital around 615 am to prepare your rooms, see your patients, start any necessary IVs, lines etc.  Cases are ready to go around 7:15 at most hospitals.  As a resident you will typically stay with your patients for the duration of their case.  On a typical OR day with bread and butter abdominal surgery you oversee 4-5 cases a day.  At the end of the day you are relieved to go pre-op the next day’s patients (physical exam, brief H&P).  As an attending, the field is shifting to more of a perioperative & Anesthesia Care Team model.  This usually involves a physician overseeing the anesthesia to 3-4 cases simultaneously.  Nurses or residents work directly beneath the attending at the patient’s bedside.

 

  • What type of lifestyle can a Anesthesiologist expect?

Anesthesiology is far from a “lifestyle” specialty – busy practices will necessitate call (usually a weekend a month, or one night in seven as “first call”).  That being said, anesthesia has the perk of more defined hours than many other specialties.  When cases are done in your operating room, you are free to go home.  There are no follow up visits in clinics, floor management or chronic care with which to be concerned.

 

  • What is the average salary of a Anesthesiologist?

Typically new graduates will make around $250,000 average, depending on geographic location.  After a few years of practice (or with partnership) salary typically rises closer to $330-$350k per year.

 

  • What is the job market like for Anesthesiology?

There are always jobs for anesthesiologists.  Availability is geographically dependent, however.   If you are dead-set on working in midtown Manhattan you will have to take a pay cut, and your  job search will be a bit more labored.

 

  • What can you tell us about Anesthesiology Sub-specialties?

Typically the sub specialists will spend one extra year as a fellow (PGY5, five years total).   There are only a handful of ABA-recognized fellowships at this time.  Pain medicine, critical care medicine, cardiovascular anesthesia and pediatric anesthesia.  Experts predict there will soon be board-certification in obstetrics, neuro, and local anesthesia.

 

  • What are the potential downsides of Anesthesiology that students should be aware of?

I am always asked about the political climate of anesthesia, and the supposed “take over” by nurses.  This is something to consider before entering the field – the role of the anesthesiologist is always evolving, we are seeing a shift towards perioperative management and an “anesthesia care team” model being emphasized so physicians can manage multiple cases at the same time.  No one can predict what legislation will mandate in the future.  It goes without question that a physician-trained anesthesiologist will always be a necessity at major medical centers – and the need for good physicians will always be greater than the supply.

 

  • What else would you tell medical students who are considering Anesthesiology?

Spend time following anesthesiologists in the hospital setting.  If you know any anesthesiologists privately, try and assess how happy they are with their career choice.

 

Editor’s Note: For more help choosing a specialty in medicine, I highly recommend The Ultimate Guide to Choosing a Medical Specialty Spotlight Interview: Why Did You Choose Anesthesia? (Emory Resident).


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Spotlight Interview: Why Did You Choose Urology? (USC Resident)

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Choosing a Specialty, Urology, Why did you choose....?

June 4, 2012

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urology1 Spotlight Interview: Why Did You Choose Urology? (USC Resident)

 

A Urology Resident’s Perspective: From an interview with a urology resident from the University of Southern California (USC) Medical Center in Los Angeles, California.

Part of an interview series entitled, “Specialty Spotlights“, which asks medical students’ most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • What attracted you to Urology?

Many factors attracted me to Urology…

1) Surgery – If you are interested in surgery then definitely consider urology. Urology has a very broad range of surgeries ranging from microsurgery to complex open abdominal cases with extensive reconstruction. If you are into technology, urology is often on the forefront of new surgical modalities such as robotic surgery.

2) Clinic – Many urologic issues are often dealt with in an outpatient clinic. There is definitely continuity of care as many urologic issues aren’t resolved with one clinic visit. Whether it is a patient with recurrent kidney stones that needs a metabolic work up, or a post surgical cystectomy patient for bladder cancer that you are surveying.  Also many urologic procedures can also be done in an office setting such as cystoscopy, ureteral stent placement, vasectomy, prostate biopsies, plus much more.

3) People – Your work environment and colleagues are an important factor in choosing a specialty. Although it is a stereotype, it is often true; urologists are known to be fun, down to earth, and happy surgeons. Also, urology is a small field. You will find when you go on interviews, you will get to know the majority of your interviewing cohort by the end of the interviewing season. Similarly, most academic urologists know the other academic urologists across the whole country. Everyone is familiar with one another and this lends to a tight knit group of specialists.

4) Lifestyle/Flexibility – This is definitely a factor to consider when choosing a specialty. Not only are urologists relatively well compensated as it is a surgical specialty, the field also lends itself to a relatively nicer lifestyle if that is what you are looking for. Although training is rigorous, once you are practicing there are generally very few urologic emergencies. Urology also allows you to be flexible with how you want to practice. You could do very well practicing as a general urologist. You can also choose to sub-specialize by pursuing one of a number of fellowships. These include urologic oncology, endourology/stone disease, pediatric urology, transplant, reconstruction, female/neuro urology, minimally invasive surgery, and andrology/infetility.

  • Describe a Urologist’s typical work day?

This can vary widely depending on if you are in academics or private practice, but in general urologists operative 2-3 days a week. The rest of the week is split between research and clinic.

 

  • What type of lifestyle can a Urologist expect?  

Few urologic emergencies lend to a nicer lifestyle for urologists. The field is flexible and you can generally choose to be as busy as you would like. Because it is a surgical field you can still expect relatively early mornings.

 

  • What is the average salary of a Urologist?

See the excellent positings on this blog for average salaries. [Link from the Editor: The Ultimate Guide to Physician Salaries]

 

  • What is the job market like for Urology?

In general, very good. Very few urologists are trained each year (approximately 270). This leads to a shorter supply for a growing field. Definitely keep in mind that in more desirable locations, jobs may be more difficult to find, and you will take a substantial pay cut than if you practiced in a more rural setting.

 

  • What can you tell us about Urology Sub-specialties?

Urologic oncology – 1-3 extra years of fellowship (accredited vs non accredited). Lifestyle is more varied as your patients are, in general, more sick. Variety of surgery from robotics to massive abdominal surgery.

Endourology/stone disease – 1-2 years of fellowship. Master endscopic/percutaneous management of stone dsease.

Female urology – 1-2 years of fellowship. Nice lifestyle, very good job market as they are in high demand.

Neurourology – 1-2 years of fellowship. Urodynamic evaluation of patients with voiding disorders.

Infetility/Andrology – 1-2 years of fellowship. Very few fellowship spots available. Very nice lifestyle, more competitive job market.

Pediatrics – 2-3 years of fellowship. Also competitive job market especially for major cities.

Transplant – 1-2 years of renal transplant fellowship. Varied lifestyle depending on seniority/call schedule.

Reconstruction – 1-2 years of fellowship. Nice lifestyle.

 

  • What are the potential downsides of Urology that students should be aware of?

It is not a field to go into if you are not into surgery. The surgical training is very rigorous. Most programs are 5-6 years in length, and you can expect early mornings and late evenings. Although times are changing, urology is still a male dominated field which can be a deterrent to many women who may be interested. The good news is that there is a rise in female applicants each year and there is a growing need and demand for urologists who are female.

 

  • What else would you tell medical students who are considering Urology?

If you are at all interested in surgery, definitely consider exposing yourself to urology by doing a rotation in medical school. Most medical students have little to no exposure to urology and much of this exposure is all in the classroom setting. Many people (including patients, medical students, and practicing physicians) have little knowledge of the field and what we do. Although it is a unique specialty, you can tailor your practice to your own wishes and desires: more clinic, more in-office procedures, more big whacks, etc.. Definitely check out www.urologymatch.com, which is surely the best resource for medical students and has many articles as well as an active message board. Also check out the official American Urologic Association at www.auanet.org.

 

Editor’s Note: For more help choosing a specialty in medicine, I highly recommend The Ultimate Guide to Choosing a Medical Specialty Spotlight Interview: Why Did You Choose Urology? (USC Resident).


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Radiology: “Don’t Choose Something You Hate”

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Choosing a Specialty, Compensation, How to match in....?, Radiology, The Match, Why did you choose....?

June 3, 2012

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A Radiology Resident’s Perspective: An interview with a radiology resident who has asked to remain completely anonymous for reasons you may soon understand.

Part of an interview series entitled, “Specialty Spotlights“, which asks medical students’ most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • What attracted you to Radiology?
radiology vs surgery Radiology: Dont Choose Something You Hate

The money.  Choosing a specialty for its salary is considered an anathema in the medical community.  Because the discussion of salary is taboo, many medical students have taken to talking about a specialty’s “lifestyle.”  In reality, lifestyle and salary/work ratio are near synonymous.  With the notable exceptions of radiation oncology and dermatology, radiology is unquestionably at the top of the heap.  Factoring in vacation, hours, and salary the average private practice (PP) radiologist made nearly twice as much per hour as a general surgeon.  If you are going to sacrifice your youth to medical education then you should be lucratively rewarded.

radiology question Radiology: Dont Choose Something You HateAs I learned more about radiology, I realized that the specialty has all sorts of unique advantages.  Without a patient base, a radiologist is free to move about the country at will.  They can work from home or from anywhere in the world with teleradiology.  This mobility, free of the fetter of patient care, continues to drive radiologist’s salaries higher. Radiologists tend to practice longer than any other specialty (except pathology) presumably due to the relaxed work environment.  However many radiologists retire early, which is silly because radiology differs little from retirement.

When I began my clinical rotations, I made a very important and life altering discovery.  Clinical medicine sucks.  I hated the whole experience.  I agonized at having to pick between such awful choices.  People kept telling me, “Just do what you love!”  I have different advice, “Don’t do what you hate!”  Radiology is unique in that we have an integral role in patient care without having to be dragged into any of patient care’s unpleasantries.  I am no longer screamed at by patients at 2 am because they think nexium is causing back pain.  I no longer have to hold a screaming child for a shot or calm down a sundowning gomer.  If you have the opportunity to save lives from a distance, I highly recommend it.

list2 Radiology: Dont Choose Something You Hate

 

While the lifestyle is enviable, radiology is anything but easy.  Radiology is an intellectually rigorous specialty that encompasses the entire breadth of medicine.  The training requires extensive study of anatomy, pathology, physics, and treatment.  In emergencies, films must be read quickly and accurately.  Entire medical treatment plans are sometimes based on a radiologist’s dictation.  Medical imaging continues to be at the forefront of modern medicine. Technology advances rapidly and a radiologist should expect to spend most of his or her career keeping up with current technology.

 

  • Describe a Radiologist’s typical work day?

The typical radiologist comes to work and reads films in the dark for the majority of the day.  The work day in punctuated by phone calls, administrative responsibilities, and procedures (thoracenteses, liver biopsies, chest tubes, barium swallows, etc.).  Contrary to popular belief, these procedures are performed by general radiologists with no special “interventional” training.

 

rads Radiology: Dont Choose Something You Hate

The Radiologist’s Dilemma: This radiologist can’t decide which LED TV to buy. A common problem…

  • What type of lifestyle can a Radiologist expect?  

Based on information on the ACR website, job postings, and anecdotal experience the average radiologist works about 50 hours a week.  Generally this is a 7am-4pm M-F with one short call until 9pm and 1-2 weekend days per month.  Work schedules are flexible.  It is also possible to rearrange the work schedule in many different ways with your partners.  Our work schedule isn’t tied to patient management so we can divide it anyway we wish.  PP radiologists average 10 weeks of vacation per year, a figure that makes teachers envious.

  • What is the average salary of a Radiologist?

Based on the most recent Merrit Hawkins salary scan the average radiologist makes $417,000(1).  Andrew has compiled the entire source of physician salary data into one easily searchable article.  The Ultimate Guide to Physician Salaries. I highly recommend it.

 

  • What is the job market like for Radiology?

The job market is somewhat tight at the moment, though this is not unique to radiology.

 

  • What are the potential downsides of Radiology that students should be aware of?

My specialty is perfect.

 

  • What else would you tell medical students who are considering Radiology?

Don’t do what you hate.  Kill the boards and standardized tests.  Keep your options open.

 

  • How competitive is the Radiology match?

Radiology is a very competitive specialty.  The average USMLE STEP 1 is 240(2).  26% of successfully graduates are inducted into AOA.  Most have some research.  Luckily, radiology is a surprising large specialty.  With nearly 1000 positions per year, there are plenty of spots to go around.  More residency positions are created every year.  For this reason, radiology is less competitive than dermatology, radiation oncology, plastic surgery, orthopedics, otolaryngology, or ophthalmology.  Clinicians actively try to dissuade medical students from going into radiology.

 

  • What are residencies looking for in a Radiology applicant?

Personality, 3rd year grades, board scores, research.  In that order.

 

  • What else would you tell medical students who are considering Radiology?

I wish I knew how fat I would get on pre-interview dinners.  Radiology interviews are great.  If I could do it again, I would.

 

  • What should students look for in a Radiology residency?
  1. A balance of case volume and teaching:  There are “work” residencies and “study” residencies.  “Work” residencies focus on learning to read films and dictate efficiently but can lack structured educational activities such as lectures and research.  If case volume is too high, you may be trained to be a transcriptionist instead of a radiologist.  On the other hand, at certain programs the residents are underworked and spend a large portion of their day studying and researching.  While these residencies sound cushy, it is embarrassing for residents to have to fight each other for cases.  One should look for a program where the residents do not have to compete with fellows for films/cases.
  2. “View-box” teaching:  The ideal situation is that the resident reads a film independently, checks out with the attending who teaches and answers questions, and then the resident dictates a report.  The suboptimal way is that the resident types a brief preliminary report which is later finalized by an attending with no face-to-face contact.  (Though the latter situation is appropriate for senior residents reading basic films.)
  3. Modern Equipment:  Radiology is a rapidly changing field.  Don’t be behind in the technology before you even start!
  4. Residents and Faculty:  Go someplace where you will fit in and feel comfortable.
  5. Facilities:  Palace or dump?
  6. Food:  You are what you eat.
  7. Fitness:  For something to do with all your free time.

 

  • What other advice do you have for students applying to Radiology?

I met an old southern radiologist when I was a medical student.  He looked like a colonel in the Civil War.  Grizzled and wizened, he looked me straight in the eye and asked, “Son, what is it ya wanna do with yo life?”

“Radiology, sir.”

He said, ”Well that shows remawkable judgment and good sense.”

You are choosing a career for LIFE.  Choose a specialty that you will enjoy when you’re 64.  Most people have the same specialty longer than they are married.  Treat your specialty choice with the same careful consideration as you would with any major life decision.  Or don’t, and go into ER.  What do I care?  Peace.

 

MYTH OR FACT:

Switch to radiology Radiology: Dont Choose Something You Hate

Physicians from all specialties frequently switch to radiology after realizing their mistake

  1. Radiology is going to be Outsourced! – A favorite MYTH of surgeons, foreign doctors, and the ignorant.  First and foremost, as long as radiology is considered to be medical practice, then it will require aUS medical license.  Credentialing is increasingly difficult and the notion that any hospital would credential an unknown inRanipet,India is absurd.  Second, general radiologists now perform far too many procedures to not have a physical presence at a hospital.  And third, there is no way to sue that physician in Ranipet.
  2. Radiology doesn’t have enough patient contact  – MYTH.  Radiology has as much patient contact as you want.  At any time, I can put down my mocha latte and go talk to my patients.  I don’t, but I could.  Radiology requires a one year internship that is designed to shatter any delusions medical students still have about patient contact.
  3. Radiology has turf wars with other specialties.  – This is FACT, but it is not unique to radiology.  The most notable radiology turf war is with cardiologists over cardiac imaging.  Clinicians reading their own films is grossly inappropriate.  Clinicians are 4 times more likely to order a film if they are reading it themselves3.  Beyond the unscrupulous avarice, the radiation from unnecessary studies causes direct harm to patients.
  4. Radiologists sit in the dark all day – FACT, but there is nothing stopping me from turning the lights on while I read films.

 

Editor’s Note: For more help choosing a specialty in medicine, I highly recommend The Ultimate Guide to Choosing a Medical Specialty Radiology: Dont Choose Something You Hate.  If you are interviewing or working on your application for radiology or another specialty, check out First Aid for the Match and The Successful Match: 200 Rules to Succeed in the Residency Match.









 

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Spotlight Interview: Why Did You Choose Urology? (OSU Resident)

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Choosing a Specialty, General Surgery Rotation, Urology, Why did you choose....?

June 1, 2012

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urology residency1 Spotlight Interview: Why Did You Choose Urology? (OSU Resident)

A Urology Resident’s Perspective: From an interview with a urology resident The Ohio State University Medical Center  in Columbus, Ohio.

Part of an interview series entitled, “Specialty Spotlights“, which asks medical students’ most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • What attracted you to Urology?
I knew that I was attracted to surgery, but I was not interested in living a “surgeon lifestyle.”  Many doctors, including surgeons in other specialties, recommended during medical school that I check out urology.  Urology was not on my differential and the thought of dedicating my life to the urinary tract did not seem appealing.  I was convinced to do a 2 week surgery subspecialy rotation in urology.  I was amazed at the breadth of surgical procedures they performed.  I also enjoyed all the different equipment (or toys) that they utilized.  There was also a lot of variety in clinic between medicine and office procedures.  I appreciated the fact that urologists worked hard, but most days were still done at a reasonable hour.   This allowed the urologists to maintain a healthy balance between work and life outside the hospital.  Probably, the deciding factor was how genuinely happy the urologists were and when asked, all of them stated they would choose urology if they had to do it all over again.

 

  • Describe a Urologist’s typical work day?

The work week is usually split fairly evenly between clinic and OR.  I would say that most urologists have around 2 OR days and 3 clinic days, although many clinic days may have time dedicated to office procedures.  Obviously, the clinic days are going to be more routine office hours.  OR days vary a lot depending on what type of cases you perform.  Most procedures are outpatient and relatively short.  If you plan to do a lot of cancer surgery then you will do some longer cases and therefore will have some evenings spent operating.

 

  • What type of lifestyle can a Urologist expect?  

It is still a surgery field which means you still have early rounds due to early OR cases.  I feel that residency hours are comparable to other surgery fields, with the main difference maybe being home call for urology versus in-house call for many other fields.  I feel there is a light at the end of the tunnel though.  In practice, most days will have office-hours type of schedule.  A lot depends on what types of cases you decide to do and how the call is split up.  In general, there are less emergent surgeries in urology than most other fields.  If you are at a busy hospital there still may be ER consults and inpatient catheter issues that will need to be addressed in the middle of the night.  I think that most nights, even on call, you can expect to get a decent amount of sleep.  Relative to some surgery fields, you should have adequate time to spend with family and doing hobbies during the evenings and weekends.

 

  • What is the average salary of a Urologist?

Overall, probably between $200,000 and $600,000 with starting salary between $200,000 to $400,000.  A lot has to do with private practice versus academics and how saturated the specific market is.  I think most academic urologists will make between $200,000 to $300,000, but with certain bonus/incentive packages may eventually make more.  If you are starting off in a bigger practice in a more competetive location, you will likely start off closer to the $200,000 range, but with time can build up your practice and eventually be making greater then $500,000.  There has also been a trend towards hospital employed urologists.  These hospitals will often provide higher starting salaries (e.g. closer to $400,000), but may have more of a ceiling on how much you can earn from there.

 

  • What is the job market like for Urology?

Most of the big, destination type cities are relatively saturated.  Having said that, you can likely get a job just about anywhere but you may just have to take a big pay cut.  There are many relatively rural hospitals that are desperate for urologists and will pay good money to lure you out there.  I would say in general that the job market is good, but you may need to have some flexibility on where you want to end up practicing.

 

  • What can you tell us about Urology Sub-specialties?

Urology fellowships are 1-2 years.  As opposed to the trend in many other surgical fields, you definitely do not need a fellowship to get a good job.  Most residents will only do a fellowship if they want to do academics or if there is a specialty field that they feel they did not get adequate exposure to during residency and they desire extra training in.  In some big cities, fellowships may give you a marketable skill, but most fellowship trained urologists will still practice general urology with maybe a slant towards that specialty.  If you really just want to do one specialized field and not other parts of urology, then academics is likely your best option.

 

  • What are the potential downsides of Urology that students should be aware of?

Urology is a tough surgical residency.  With any type of surgery comes complications and stress.  Although call may be better than some surgery fields, there are still going to be emergent cases or patients crashing in the middle of the night and on weekends.  You are dedicating yourself to the urinary tract which means a lot of bloody urine and prostate exams.  Everytime you tell people what field you’re in you have to answer the question, “why urology?”

 

  • What else would you tell medical students who are considering Urology?

If you want variety and enjoy being busy then this is a good field to consider. Compensation is definitely on the higher end which is a bonus!

 

Editor’s Note: For more help choosing a specialty in medicine, I highly recommend The Ultimate Guide to Choosing a Medical Specialty Spotlight Interview: Why Did You Choose Urology? (OSU Resident).


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Spotlight Interview: Why Did You Choose Family Medicine? (Oregon Resident)

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Choosing a Specialty, Family Medicine, Family Medicine Rotation, Why did you choose....?

June 1, 2012

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family medicine Spotlight Interview: Why Did You Choose Family Medicine? (Oregon Resident)

 

A Family Medicine Resident’s Perspective: From an interview with a family practice resident at Oregon Health Sciences University in Portland, OR.

Part of an interview series entitled, “Specialty Spotlights“, which asks medical students’ most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • What attracted you to Family Medicine?
Autonomy. Mobility. I wanted the sense that I was choosing a specialty that would allow me to work as much or as little as I wanted and that would allow me to place my family in a town of our choosing (likely a small town).
I also love the tradition in family medicine of trying to manage a patient by yourself as much as possible. There are a lot of efficiencies and preventative virtues in this approach to care. I feel like so much can be done in a small community that keeps thousands of people from ever having to be admitted to a hospital.
I love the intellectual challenge of receiving a patient into my office and managing all of their complaints. The situation demands that I be fluent on a variety of medical topics and able to comment on the current state of the medical literature. I really enjoy the challenge to read broadly and competently on a range of medical issues, it allows me to possess a synthesized view of medicine and patient care, to be sure I am not engrossed in too many minute details.

 

  • Describe a Family Physician’s typical work day?

Most days will start at 8:00 am. We see patients until 11:00 and then break for Lunch until 12:30. We see patients after lunch until 4:30. A large number of family docs will have a half-day on Friday.

 

  • What type of lifestyle can a Family Doctor expect?  

Your lifestyle will be pretty good. Weekends are virtually always free if you do not do hospital work. You will have regular call, but you rarely have to go in.  Most problems while you are on call are resolved over the telephone.

 

  • What is the average salary of a Family Practice Physician?

There is a great range of earning potential in FP.  The average salary is around $150,000.  However, you can see fewer patients in a day, or work fewer days in a week and earn less than this. If, however, you see patients quickly, become medical director of a nursing home or two, work extra on the weekends, etc, it is very possible to make much more than this.

 

  • What is the job market like for Family Medicine?

Honestly, it couldn’t be better. Family docs can go anywhere they want. Lots of recruiters will call you throughout your residency. There is a great need of primary care docs in every corner of this country.

 

  • What can you tell us about Family Medicine Sub-specialties?

There are a few options as a family medicine physician. Some of the fellowships include hospital medicine (i.e. become a ‘hospitalist’), geriatrics, adolescent care, and Sports medicine. For the most part, fellowships are one year in length. Sports medicine doctors end up making a bit more money than a generalist and the other sub-specialties.

 

  • What are the potential downsides of Family Medicine that students should be aware of?

In family medicine there is a lot to the business side of things. You will be responsible for managing much of the business side. If you are not a good businessperson, not organized, or dislike that type of thing, this part of the job could be a real drain. The salary is on the lower end for physicians, but it is still a very good living.

 

  • What else would you tell medical students who are considering Family Medicine?

If you want to do outpatient care in a small community, this is a great field.

 

Editor’s Note: For more help choosing a specialty in medicine, I highly recommend The Ultimate Guide to Choosing a Medical Specialty Spotlight Interview: Why Did You Choose Family Medicine? (Oregon Resident).


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Spotlight Interview: Why did you choose OB/GYN?

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Choosing a Specialty, OB/GYN, OB/GYN Rotation, Why did you choose....?

June 1, 2012

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OB.GYN Spotlight Interview: Why did you choose OB/GYN?

 

An OB/GYN Resident’s Perspective: From an interview with an obstetrics and gynecology resident at Banner Good Samaritan, in Phoenix, Arizona.

Part of an interview series entitled, “Specialty Spotlights“, which asks medical students’ most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • What attracted you to OB/GYN?

I enjoyed the opportunity of working with women over the course of their lifetime health care needs.  From adolescent to geriatric patients you can develop life-long relationships with your patients and families.  Labor and Delivery is exciting and fun to be a part of.  Delivering patients was rewarding and the patients generally are very appreciative of your service. I also enjoyed working with the type of people who typically choose Ob/gyn as a career. I tried to talk myself out of it because of what others had to say, but throughout 3rd year medical school, every subsequent rotation came back to how much I enjoyed Ob/Gyn and I realized that I wouldn’t have been happier in any other specialty.

 

  • Describe an OB/GYN typical work day?

Usually it starts early (to the hospital before 6 most days, this will get better after residency), postoperative and postpartum rounding on patients in the hospital then usually clinic 3-4 days per week.  Most Ob/Gyn’s will have one full day of surgery per week.  Depending on the group you practice with, you’ll be on call about every 4th night for deliveries and one weekend a month.  Clinic may be interrupted by deliveries but they are usually quick.

 

  • What type of lifestyle can an OB/GYN expect?  

It is highly variable, if you choose to be on call for all of your patient deliveries, you can expect to be interrupted frequently as babies are born at all hours.  However most practices will share call amongst the group and with other groups.  Usually Ob/Gyn’s will be on call every 3rd-4th night and maybe one weekend a month.  That is typically home call and you come in for deliveries only. Many Ob/gyn’s are working parents and often female with a relatively normal home and family life.

 

  • What is the average salary of an OB/GYN?

Salary is highly variable based on call schedule and region but most will typically start in the low 200’s initially for most urban areas.  Rural regions tend to start much higher but the call schedule can be more demanding as well.  It is not unusual to increase significantly, again based on call schedule and delivery volume.

 

  • What is the job market like for OB/GYN?

Great! As long as people keep having babies!  There is a projected shortage in all aspects of medicine and Ob/Gyn is no different.  You can typically find a job close to any area where you may want to live.

 

  • What can you tell us about OB/GYN Sub-specialties?

All subspecialties are three year fellowships: Gynecologic oncology, Maternal Fetal medicine, Reproductive endocrinology and infertility and urogynecology.  Salaries and lifestyles are generally improved with all of those specialties to varying degrees and there is always a market for them.

 

  • What are the potential downsides of OB/GYN that students should be aware of?

Like I mentioned before, babies are born at all hours, especially at 3 o-clock in the morning.  However you can make the schedule what you want, if you join a large group you’d have to take less call but you’d likely be busier during those call nights.  Malpractice insurance and lawsuits are a well known downside to the field. As long as you understand this going into it and it is not a surprise, it will not be a problem.

 

  • What else would you tell medical students who are considering OB/GYN?

In the end you choose a specialty that you really enjoy. Don’t choose solely based on lifestyle or salary.  Don’t try to fool yourself either though, those things are important but if you hate your job, it makes for a miserable lifestyle.

 

Editor’s Note: For more help choosing a specialty in medicine, I highly recommend The Ultimate Guide to Choosing a Medical Specialty Spotlight Interview: Why did you choose OB/GYN?.


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Spotlight Interviews: Why did you choose general surgery?

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Choosing a Specialty, General Surgery, General Surgery Rotation, Why did you choose....?

May 31, 2012

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A General Surgery Resident’s Perspective: From an interview with a general surgery resident at Orlando Health, in Orlando, Florida.

Part of an interview series entitled, “Specialty Spotlights“, which asks medical students’ most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • What attracted you to General Surgery?

I appreciate the combined operative and medical management of patients. Surgeons make definitive management of patient issues. There is a great variety of operative procedures. As a general surgeon I am able to care for both long and short term patient management scenarios. There is a great deal of job opportunities and availability. I enjoy team-based patient management.

 

  • Describe a General Surgeon’s typical work day?

I usually wake up at 0400,I am at hospital by 0500 to round on patients until about 0700. I will be in the OR from 0700 until about 1600 with intermittent 30-60 minutes breaks between cases to eat, follow-up on patients, and see new consults. From 1600-1800 we follow-up on outstanding patient issues and setup for following day. On good days, I return home and from 1800-2000 I study for following day cases and current patient problems. On non-operative days, simply change the OR times  to clinic from 0800-1600.

 

  • What type of lifestyle can a General Surgeon expect?  

As a general surgeon I work weekends at least 2-3 times per month. The amount of free time you will have is extremely dependent on your sub-specialty choice. Private practice surgeons enjoy significantly more free time while surgeons in academic practice spend more time with research and have less operative/clinic time generally. Call is usually taken for 24 hours periods and you will be working most of the day and night. Some surgeons have a tendency to scheduling elective cases during their call days, but this depends on how difficult your call is.

 

  • What is the average salary of a General Surgeon?

The overall salary of a surgeon is highly variable amongst sub-specialties, typically  between $250,000-$500,000.

 

  • What is the job market like for General Surgeon?

There is no lack of general surgery positions. I would say they are extremely available for both private practice and academic positions. There is some variability among sub-specialties. However, overall, we are one of the most high recruited specialties.

 

  • What can you tell us about General Surgery Sub-specialties?

Residency for general surgery is 5 years mandatory and more commonly 1-2 years research years during PGY2 or 3. Therefore, many general surgery residencies last 6-7 years before fellowship. Fellowships typically last 1-2 years. Subspecialties have more call and higher salary. Additionally, sub-specialties are generally in more demand than general surgeons.

 

  • What are the potential downsides of General Surgeon that students should be aware of?

The schedule is less flexible due to emergent surgical problems. Surgical shift hours are not reliable and typically cases will be delayed or run over and require staying at the hospital beyond a call or shift. This leads to a schedule that can be variable. Training programs are not as “intense” as they were historically, although there are still high expectations of surgical residents. There are not many other residents/doctors who work as hard as general surgeons.

 

  • What else would you tell medical students who are considering General Surgery?

One thing students should realize is that there is more peri-operative management being handled by hospitalist services for elective surgical problems. Therefore, some of the duties and responsibilities of a surgeon 20 years ago and being placed in the hands of non-surgeons. Additionally, surgical critical care services are beginning to  limit the medical management requirements of general surgeons.

 

Editor’s Note: For more help choosing a specialty in medicine, I highly recommend The Ultimate Guide to Choosing a Medical Specialty Spotlight Interviews: Why did you choose general surgery?.


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