This list is part of a series of articles about the best books for medical students. Click on the Med School Books Main Page to see other lists including the best books for each year in medical school, the best books for each clinical rotation, and the best books for USMLE Steps 1, 2, and 3.
Many residents will say that there is no time for reading during your internship, but I disagree. You will work very hard, but there are still three types of books that you will need to have access to: 1) great reference material while you are working, 2) more in-depth reference material when you are home so you can read about your difficult patients, 3) "other" books that are either not related to work at all or only loosely related to work. Below is my list of the Top Ten Books for newly minted interns. Good Luck!
Updated May 2015
1. House of God:
I debated for a long time where to put this book on the list, or if it should even be on the list at all. As I shuffled the books in my list, this one kept coming to the top. The truth is, every intern and resident, no matter your specialty, should read this book. Whenever I ask older docs what books new residents should read, this is the first book they mention. It is a classic, quintessential diary of one man's internship in Boston. I don't want to build it up too much, but trust me, you NEED to read this book.
2. Pocket Medicine:
In the category of "pocket reference materials to use at work" nothing is better than Pocket Medicine. The product is unmatched in my opinion. The book addresses common diseases we will all encounter and takes the reader on a step-by-step course from diagnosis to long-term management. There is no better use of your white coat pocket.
3. On Call Principles and Protocols:
While I feel strongly that Pocket Medicine is the best product on the market, On Call Principles does come in second. Some argue that the format is more inviting and the design more elegant, which is true. If this is important to you, On Call Principles is your book. If the content is more important, you will probably like Pocket Medicine better.
4. First Aid for the USMLE Step 3:
It is never too early to start studying for Step 3. Many of you will put off this exam until late in your residencies, something I do not understand. If you take the exam during your internship the material from medical school will be more fresh in your mind, and you will not have the exam hanging over your head throughout residency. If you did well on the previous Steps, a quick breeze through First Aid will get you up to speed. Don't spend too much time studying for this one.
5. The Washington Manual Internship Survival Guide :
This unique book is a change of pace from most pocket reference manuals. It focuses a bit more on procedures and general resident life, but is also a great medical reference.
6. Tarascon Pharmacopedia:
As I have said in other posts, a great pharm book is a huge asset in residency. We all have phones and apps, but if you have an easy-to-use pharmacology reference like Tarascon, you will find that it is much faster and more efficient because you will know exactly where things are. This is a GREAT book.
7. The Sanford Guide to Antibiotic Therapy:
I found myself borrowing other students' and residents' Sanford Guide so long that I final got my own. You will never remember all of the bugs and drugs material, and there will always be patients with obscure infectious diseases. This is a great book to keep in your white coat or in your call bag, you will use it weekly no matter your specialty.
8. The Little ICU Book:
You don't need an ICU manual, but your life will be much more simple with one. Whether you spent time in the ICU as a student or not, your experience as a resident is different. There are so many things that you need to be able to juggle, it is often overwhelming. A great reference book in your workroom will become your best friend. I prefer the Little ICU book, but many residents also like the Marino's ICU Book which is also very good.
In the category of "reference material for home use" I put Harrison's first. Most students and residents are familiar with this famous text. It is thorough, up-to-date, and and not too dense. You will always have difficult patients on your service. You will be thinking about them as you go to bed and as you wake up, you need a great and complete reference at your home to read about them.
10. A Crock Pot Recipe Book:
No, I am not joking! You aren't going to have time to cook, but you have to find a way to eat healthy. Even if your hospital provides food money, you can not eat every meal at the hospital, you will go insane. Buy a $50 Crock-Pot, learn a few easy recipes, throw the food in at 6:00 am and have a great meal when you get home.
This list is part of a series of articles about the best books for medical students. Click on the Med School Books Main Page to see other lists including the best books for each year in medical school, the best books for each clinical rotation, and the best books for USMLE Steps 1, 2, and 3.
This list of books was specifically created to help medical students. However, I would suggest the same books to anyone taking an undergraduate course in anatomy, to dental students, optometry students, podiatry students, physicians assistant students, advanced nursing students, etc. etc. When you are studying anatomy there are a few things you have to focus on: 1- Learning the name and location of the structures, 2- learning to identify the important anatomic relationships in the body, and 3- learning the clinical correlations related to the important relationships. Your tests will focus on each of these areas, so you must focus on them as well.
Updated April 2015
1. An Atlas:
Your first goal when starting your anatomy class will be to find the atlas that will help you learn. I created a separate list of the best available anatomy atlases a few months ago. I am partial to Netter's because I like bright colors, but each atlas has its own advantages and disadvantages. Below are a few links to the best known atlases.
An atlas is essential for learning WHERE anatomy is, but you must also learn WHY anatomy relationships are important; you will be tested on both paradigms. An anatomy textbook will teach you the pertinent anatomical/clinical relationships. I prefer Clinically Oriented Anatomy because it is brief and very high yield. I have also heard good things about Saladin Anatomy and Physiology.
3. A Dissector:
A 'dissector' is a manual that will guide you through dissection in the anatomy lab. Your class will likely suggest a specific book for the lab itself. Let me also recommend purchasing an extra copy from which to study. Grant's Dissector works just fine. You will want to know all the important structures that you dissected, but you will NOT want to study out of your anatomy lab book! Gross.
To do well in an anatomy class you do not need to think, you only need to memorize. Flashcards are a must. Use them on the bus, trains, waiting in line, brushing your teeth, etc. Don't waste time making your own, you can buy a used box of beautiful flashcards for around $15. Again, my favorite are the Netter's Anatomy Flash Cards, they are bright and color coated for easy memorization.
As an aside, I have heard of a few people using 'coloring books' to study for anatomy. This actually sounds intriguing to me and I wish I heard about it earlier. Many companies make these books, here is a link to Netter's Anatomy Coloring Book .
5. Anatomy Review Book:
I have raved about the BRS Series of review books before and I will again. The BRS Gross Anatomy review is concise (albeit 500 pages) and high yield review of everything to do with anatomy and its clinical correlations. The best book for high yield review, however, is likely the First Aid for the Basic Sciences, General Principles. This will include review of many other subjects, but it is very high yield and a fantastic resource.
If you thought 'gross' and 'disgusting' were adjectives that could only describe medical conditions, think again. Over the years, we in the medical field have developed our fair share of revolting medical therapies. After the great success of The Top Ten Most Disgusting Medical Conditions, I decided I needed to also divulge my Top Ten Most Disgusting Medical Therapies. The idea for this article was born while working with a gastroenterologist in the hospital. We were discussing a patient with clostridium difiicile (nicknamed C-diff), a terrible infection of the colon. The medical field has developed some great therapies for C-diff including antibiotics and, when necessary, surgery. Unfortunately, the infection is notoriously difficult to treat and sometimes the medicines do not help. As we were sitting in the hospital discussing a patient the gastroenterologist asked me a shocking question.
"So, do you think it is time for a fecal transplant?"
"A what !?" I said.
"A fecal transplant. You know, implanting another person's feces into this patient's colon to treat the C-diff?"
I thought I was going to throw up right there in the hospital. I was sure he was kidding, he had to be, right? But there he sat, totally serious and staring at me. He was actually shocked and disappointed that I had not thought of it myself. How had I never heard of this before? Fecal transplant! Gross.
Well, as it turns out, fecal transplant is a very well researched and well known therapy for C-diff infections. The theory behind its use is also very sound and well documented. As I progressed further in my training I began to mention it as a possible therapy for late stage C-diff infections without even thinking about how gross it actually is. And that folks, is how really really gross things become so accepted in medicine: desensitization.
And now, the Top Ten Most Disgusting Medical Therapies
Note: All of the procedures are STILL IN USE!
The art of bleeding the body for medicinal purposes is one of the oldest techniques in the world. The practice began more than 2,000 years ago independently in many parts of Asia, Africa, and Europe. It was initially thought of as a way to balance the humors in the body. Humorism is the idea that the body is made up of four distinct body fluids, blood being one of the four. Illness, then, was the misalignment of these fluids into abnormal proportions. Therefore, relieving the body of too much blood was one way of realigning the humors and ridding the body of illness. The practice of bloodletting was widely practiced around the world until one hundred years ago when more sophisticated science began to trump humorism. However, bloodletting has not disappeared. Doctors still use the practice in a few specific circumstances, but to distance the current therapy from humorism bloodletting, we have changed the name. We know refer to bleeding the body for medical reasons as "Therapeutic Phlebotomy". There are a few blood disorders that result in too many red blood cells. These illnesses (hemochromocytosis, and polycemia vera as examples) lead to such an over-abundance of red blood cells that the body can start to shut down. The best therapy we have for these disease, naturally, is to bleed the patient until they have a normal amount of blood. Perhaps modern medicine is not too different from Humorism!
Not only is leech therapy still in use, it is in vogue and becoming quite popular. Like blood letting, the art of leech therapy has evolved significantly and is quite different from its roots thousands of years ago. However, at the core the principles are the same: leeches suck blood. Historically, leeches were used for all sorts of things that have little scientific evidence and are no longer acceptable including treating skin diseases, back pain, and migraine headaches. They were a very important tool in the art of bloodletting, discussed above, for obvious reasons. In fact, in the 1800's the use of medicinal leeches became so popular that the species Hirudo medicinalis (the most commonly used medicinal leech) was nearly wiped out. We have recently discovered that the persistent blood sucking of leeches is still medically useful. The field of microsurgery is rapidly evolving and progressing. Today, we can take pieces of skin and tissue from one place on the body and sew the blood vessels into other places on the body. However, in order for the new reconstructions to survive they need adequate blood flow. Sometimes the blood begins to flow to the new skin on its own. For those instances where we need to help the blood flow to the new skin, we attach on leeches to suck the blood through. Beautiful.
Trepanation is simple the practice of drilling a hole into the brain. Incredibly, this is the oldest surgical procedure for which we have archeological evidence. Scientists have found hundreds of skeletons from 6,000 BC with trepanation holes in the the skull. For thousands of years drilling a hole into another individual's head was the best available therapy for anything related to the brain: seizures, migraines, psychiatric illness, confusion, etc. etc. The most incredible part of the trepanation story is that it was widespread all over the world, from Ice Age wanderers, to the Incas in America, to the ancient Chinese: we have found trepanation skulls for all these groups. Don't forget, anesthesia was invented about 150 years ago! Thankfully, drilling random holes in skulls is mostly a thing of the past. However, "trepanation" is still used to relieve pressure inside the skull during emergencies, although now we call it a "craniotomy". This is the procedure of choice if someone is bleeding inside their skull (usually the result of a traumatic accident). If the blood is not released it can cause permanent brain damage, so a hole is drilled to relieve the pressure inside the skull. It may also surprise you that the art of skull-hole drilling for random medical illnesses still occurs today (dubbed: voluntary trepanation)
7. Tooth-in-Eye Surgery
Actually, this is a very new therapy, performed in the US for the first time just a couple of years ago. The procedure, also known as Osteo-odonto-keratoprosthesis, is a last resort surgery for individuals with diseased corneas. When a cornea becomes damaged and cloudy, the eye can no longer see through it and people go blind. There are other surgeries to treat cornea disease, but when these do not work and the eye becomes scarred, the Tooth-in-Eye surgery is a great new tool. Procedure: The scarred area of an eye and eyelid are removed and are replaced with the lining of your mouth (yes, your cheek mucosa are implanted into your eye). A tooth is then removed. A hole is drilled into the tooth and a small lens is placed inside. The tooth and eyepiece are then implanted into the patient's cheek for a period of time so that they can develop a blood supply. Once the tooth and lens have a blood supply they are removed from the cheek. A hole is made in the cheek mucosa which is now covering the eye and the bone and lens are placed inside. In the end, the patients eye is made up of inner cheek skin. This mucosal layer has a hole in the from where the pupil used to be and the bone/lens allow light to be reflected to the back of the eye, allowing the patient to see again. Awesome.
6. ABSCESS INCISION AND DRAINAGE
One of the most rewarding experiences during medical training is learning how to do an I&D (Incision and Drainage). It is nothing more than surgical zit popping. Abscesses form when an infection walls itself off from the rest of the body. When this happens, copious amounts of dead tissue, pus, and blood build up in this cavity and have nowhere to go. The result is a red and painful pus ball under the skin. The therapy is simple, open up the cavity and let the pus drain out. The procedure is painful to the patient for a few moments but provides immediate relief afterward. If you are wondering what could be gross about this…you have never seen one. The puss smells awful. Abscesses form in the nether-regions of the body (arm pit, groin, anus, gums, etc). And, often the abscess are enormous, high pressure pockets that explode as soon as a blade pierces them. Check out the video if you are interested….but beware, it is truly gross.
In the article "The Top Ten Most Disgusting Medical Diagnoses" I mentioned Myiasis (maggot infestation) as the absolute most disgusting diagnosis. The overwhelmingly revolting thing about myiasis is that the infestation is unknown until you move some tissue around only to see hundreds of maggots eating a patient's flesh. Maggot therapy is a little different, but works by the same principle: maggots feed on dead skin. So, if a patient has a chronic wound that is not healing there is bound to be dead skin in the wound. Dead skin quickly leads to infection if not cut out, or "debrided". These patients are in need of constant debridement in order to keep their wounds from becoming infected. Behold, the grand entrance of the medical maggot! When used medically, maggots are always sterile and home grown. We only use specific species and keep a close eye on the wound from start to finish. But it still grosses me out.
OK, I lied. Lobotomy is the only therapy on this list which is no longer in use. However, it did not fall out of favor entirely until 30 years ago and its inventor, Dr. Egas Moniz, won the Nobel prize for developing the surgery just 60 years ago (1949). Lobotomy was a simple procedure used to cure patients of psychiatric disease. The surgeon would take a long, thin nail (called an orbitoclast) and placed it next to the eye in the eye socket. The surgeon would then take a mallet and pound on the nail until it broke the skull (think of an ice pick and a sledge hammer). The impact would break the eye socket and ram the nail into the front portion of the patient's brain. This process was repeated several times to "interrupt the connections between the front of the brain and the main processing centers of the brain." The procedure was actually highly successful, nearly every patient was cured of their psychosis. Unfortunately for the patient's, nearly all of them were also left in vegetative state. Nevertheless, the procedure was popular for many years until anti-psychotic medications were discovered. So, the next time you hear Tom Cruise tell everyone that anti-psychotic meds are evil, ask him if he would rather have a lobotomy.
Up until 20 years ago, when someone traveled to another country and came back with 'worms' it was a terrible thing. That may not be the case any longer. Recently, researchers have found that parasitic worms have great medicinal qualities. Specifically, they are the world's best treatment for allergies and can successfully treat many autoimmune disorders including Crohn's Disease, ulcerative colitis, and inflammatory bowel disease. Undergoing helminthic therapy is as easy as taking a pill; you simply drink a glass full of live, parasitic worms. Once they have colonized in your body, they begin to work against the autoimmune diseases. The success rates in recent studies is actually very impressive. While there are a number of theoretical explanations for why the therapy works, the best evidence of their effectiveness is the the fact that in countries where most humans are colonized with parasitic worms, there is virtually no autoimmune disease.
2. ELECTRO-CONVULSIVE THERAPY (aka ECT or "Shock Therapy")
When I started medical school I was shocked to learn that "Shock Therapy" was still in widespread use around the entire world. ECT is used for a wide variety of psychiatric conditions including schizophrenia, depression, and severe bipolar disorders. To complete the procedure, electrodes are placed on the scalp, the patient is sedated, and the a series of high voltage shocks are applied to the brain. Essentially, we induce a seizure in a willing person. It is not like the old movies where the shock sends the patient's body into a convulsion, these days most patient's are temporarily paralyzed during the procedure. However, though I know that it is effective, there is still something inside of me that feels uneasy about sending large amounts of electricity through the brain of an unconscious person.
1. FECAL TRANSPLANT
As my leading story alluded, fecal transplant is the real deal. It is an effective therapy for late-stage clostridium difficile (C-diff) infections. C-diff is an infection of the large intestine that usually occurs after using antibiotics. It is a normal bacterium that lives in your gut and is usually kept in check by the other bugs that normally live there. When a person takes antibiotics, the normal bacteria in the gut are often killed but C-diff is usually note affected by ordinary antibiotics. This gives C-diff free reign to take over your whole guy all for itself. We have good medications against C-diff, but they do not always work. In theory, replacing the ordinary bacteria back into the gut should bring C-diff back into check. How can we do this? Easy. By taking the feces from a healthy patient with normal intestinal bacteria and transplanting it into the patient with C-diff. So, don't get mad the next time you walk into a doctor's office and you really want an antibiotic and the doctor says "It looks like a viral infection, I don't think you need antibiotics." In reality you should thank your doctor, he/she is only trying to save you from having another person's feces transplanted into your backside.
Tapeworms are known to colonize the gastrointestinal tract of human beings. They are notoriously difficult to get rid of because they use strong teeth to latch onto the intestinal wall once they are inside the gut. The "Milk Bath" remedy is often cited as a great solution. Most clinicians and scientist will tell you that this therapy does not, or at least should not work. But that advice does not stop thousands of people around the world to continue practicing it, and openly reporting on its success. Supposedly, when you are infected with tapeworms, there is a simple way to get the out of your body–a lure. If patients submerge their backsides into a bucket of milk, or sleep with their mouths open next to a bucket of milk, the tapeworms will crawl out, preferring fresh milk to human gut. If true, the migration would be very slow and the patient would have to endure the feeling of worms crawling out of their orifices for many hours. Looking at that picture, I think I would rather stay colonized.
HIPPO SWEAT SUNSCREEN
Skin cancer is one of the most common cancers, and one of the most preventable. Wearing good sunscreen greatly decreases your risk of skin cancer. So, what is the best sunscreen? Recently, studies show that hippopotamus sweat might be the next big sunscreen breakthrough. The natural product does no damage to human skin, does not harm animals in its processing, and blocks nearly 100% of all UV rays. Sound perfect? That's because you haven't seen hippos sweat! This is not a clear, salty sweat like we have. Hippo sweat is referred to as a 'blood sweat' and is actually neither blood nor sweat, but a natural sunscreen. I really don't want skin cancer…but I don't know if I can put that stuff on my body.
INTRAVITREAL (EYE) INJECTION
This is probably the most common therapy on this entire list. Eye injections are used for everything from eye infections, to macular degeneration, to diabetic disease in the eyes. The procedure is done routinely in the offices of ophthalmologists around the world. Unfortunately, if you are diagnosed with a disease that requires medical injections into your eye, you will likely need a series of at least 3 injections. The needles used for eye injections are small, and the area is numbed up very well: most patient's report not even feeling the stick. However, something about sticking a needle in an eye just seems wrong.
The data are very limited, and I have never met a physician who endorses urine therapy. However, I can't find any information debunking the theory either. Urine has been used since Roman times for medical therapy for everything from infections to psychiatric illness. Many not in the medical field suggest that it has strong anti-cancer effects and many of us have heard that if you pee on your foot, you can cure athletes foot. None of these suggestions have much medical support, as urine is mostly made of water and electrolytes. However, urine therapy is still used in modern medicine, just not human urine. Horse mares are known to pee out a large amount of estrogen. Pharmaceutical companies have realized this and now collect female horse urine, extract the estrogen, and sell it as an estrogen tablet. Yummy.
ICHTHYOTHERAPY (a.k.a. "Fish Therapy)
The garra rufa species (a small fish, nicknamed the "Doctor Fish") lives in rivers in Turkey and Iran. For hundreds of years humans have known of their strange affection for abnormal skin. Individuals with skin rashes, skin infections, and skin growths often come to the region to let their feet soak in the water and let the Doctor Fish pick away their diseases. Recently, garra rufa fame has become more well known and the fish have been the subject of numerous medical experiments. Indeed, research is showing that they have some ability to pick away skin disorders of the feet including dermatitis and psoriasis. Those who have felt the healing power of the garra rufa say there is no pain involved, and that the experience is more relaxing than painful.
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.
As 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.
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.
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?
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.
“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.)
Modern Equipment: Radiology is a rapidly changing field. Don’t be behind in the technology before you even start!
Residents and Faculty: Go someplace where you will fit in and feel comfortable.
Facilities: Palace or dump?
Food: You are what you eat.
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?”
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:
Physicians from all specialties frequently switch to radiology after realizing their mistake
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.
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.
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.
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 one these great books about choosing a specialty. If you have already decided on radiology, I recommend the First Aid for the Match to help you get ready for interviews.
The new Medscape Physician Compensation Report identified internal medicine, family medicine, and pediatrics as the lowest earners in medicine (each with an average of less than $165,000 per year). I wanted to compare these results to the updated information from the Cejka Search group who publish data on the salaries of allied health professionals. The Cejka Database is the best place I have found for reliable information about the salaries of allied health practitioners. The list of allied health workers is long and includes:
Nurse Practitioners (NP)
Certified Nurse Aneasthatists (CRNA)
Physicians Assistant (PA)
Occupational Therapist (OT)
Physical Therapist (PT)
Dentist (DMD or DDS)
Cejka reports the following salary information for these allied health professionals. As you can see, CRNAs and Dentists earn more money than our country’s primary care physicians (pediatricians, family physicians, general internists). This is just the yearly salary information, not taking into account the number of hours worked. Very few allied health professionals work the average hours per week worked by primary care physicians in the US (60 hours is a very conservative estimate for our PCPs). This means the dollars per hour is vastly different between some allied health practitioners and our primary care doctors. How do you feel about this?
In light of the new Medscape Physician Compensation Report 2012 that was just released, I thought it was time to compile all the data on physician salaries into one place. There are many resources online that report average physician salaries, and many of them offer very different results. I recently wrote an article detailing the pros and the cons many of these online physician salary and compensation databases. However, it can be a bit tedious to go through all the work of visiting each website to compare results. So, I have done all the work for you. In this article I will present the physician salary by specialty data from all the reliable and relevant online physician salary databases. Feel free to compare and contrast the information presented by each different company.
Careers in Medicine (CiM) is a great resource for medical students and medical residents (link to my previous article about Careers in medicine). One of the greatest tools it provides is a list of salary information for each specialty. Careers in Medicine separates the compensation information using two very important distinctions: academic vs. private practice and starting salaries vs. established salaries. CiM obtains the academic salary information from the Association of American Medical Colleges AAMC Report on Medical School Faculty Salaries. The data about private practice salaries comes from the MGMA Physician Compensation Survey. Below, I have compiled a table of the salaries reported for each specialty. (Click here to download the formatted table) On the CiM website you can also see salary data for every sub-specialty; this is especially important for internal medicine, pediatrics, and general surgery where the sub-specialty choice results in very different salaries.
Compiled from the Careers in Medicine website, AAMC
Allied Physicians: Old Salary Survey
Many students use the alliedphysicians.com resource to learn about physician salaries by specialty. However, you should know that it has not been updated since 2006, so the information is likely a bit off now but the trends are still the same.
The Cejka Search Group is a great resource for salary information but also for job openings and employment information. Their physician salary survey is up-to-date and updated frequently. They freely publish their salary information in order to advertise the many physician job openings they have available.
Profilesdatabase.com is another online physician recruitment company. They also publish their physician salary data freely in order to publicize their many job openings. Like the Cejka Search, these numbers are updated frequently and seem to be very reliable.
Each year Medscape conducts a nationwide study of physician salaries and compensation. Medscape is surely one of the best online resources for researching physician salaries. (See my article here about all the different online resources, databases, and surveys regarding physician salaries) The data are a combination of over 20,000 surveys completed by physicians of every specialty all over the country. The results for 2012 were published in late April. To compare the results of the Medscape Physician Compensation Report to the other well-known online survey results, check out my ‘Ultimate Guide to Physician Salaries‘ where you can compare all the available resources.
Results: Physician Salary by Specialty
Radiology and orthopedics are again the big money winners, bringing home an average salary of $315,000. Family medicine and pediatrics earn the smallest salaries of all physicians at less than $160,000 a piece.
The Medscape survey also sheds light on some very interesting questions like ‘where in the US do physicians earn the most money?’ As you can see by the medscape graphic below, the average physician salary is nearly equal in all parts of the country. This is not the case in each specialty, but overall, there is no large difference.
Taken from medscape.com
Results: Changes in Salary since 2010
Medscape compares the average salary by specialty in 2012 to the same averages seen in 2010. The resulting data shed some light on the changes in physician salaries over the past couple years. As you can see in the graphic below, ophthalmologists have enjoyed the largest increase in salary over the past two years while radiologists, orthopedists, and general surgeons have suffered the largest decline in wage. The increase in ophthalmology compensation is interesting as they were the specialty that suffered the largest decline in salary between 2000 and 2010. What we learn from this graph is simple: those that earn the most are the the greatest risk of declining salaries. This is because those who decide how much we all get reimbursed (i.e. Medicare and Medicaid bosses) will always go after those that are earning the most money. This is exactly what is happening right now to radiology and orthopedics, and is exactly what happened to ophthalmology 10 years ago.
Results: Hours, Lifestyle, Satisfaction
In addition to salary information, the Medscape compensation report also details the number of hours worked in a week, the number of patients seen in a week, how satisfied doctors are with their specialty of choice, and many other questions. Each of these questions is divided up by specialties so we can compare the results between specialties.
Also, medscape provides a detailed report for each specialty including the above data: salary, hours, lifestyle, satisfaction, etc. Click on the specialty below to be taken to the individual report. [LOGIN REQUIRED]
Ophthalmology is pretty competitive. It is not as bad as plastic surgery, but it is one of the most difficult matches right now.
What are residencies looking for in a ophthalmology applicant?
The top programs are all academic institutions, so a good research foundation definitely helps. The field is small and well informed, they like to see early and/or definite commitment to the field.
What do you wish you knew before application/interview season?
I did not know about the postings on studentdoctor network. If you go online to the studentdoctor network website during interview season you will see that there is a place where people post interview dates and times as soon as they get them. There is usually also a calendar with all the interview dates listed. If you can not find a calendar, make your own. Often you will get interview invites and if you respond in more than a couple hours there are no more interview spots left. Check email every 3 minutes, you just have to do it. Respond to interview invitations within minutes of receiving email.
What should students look for in a ophthalmology residency?
You will have to decide for yourself what options you prefer, but here are some of the most important questions when evaluating a program because they represent major differences and distinctions: location, small vs. large program (i.e. 3 residents per year vs. 8 per year), front loaded work and call vs. evenly distributed, home vs. in-house call, research faculty/area/time devotion/expectations, strength and notoriety of the faculty, training style (autonomy vs. faculty guidance), facility and equipment (new slit lamps? teaching scopes? etc), is there a VA, is the VA hours away or in another state, is the VA clinic resident run. In my opinion, a strong resident run VA clinic is a must.
What other advice do you have for students applying to ophthalmology residency?
It’s early match so somehow you need to try out the rotation and decide early. Once make a decision, you need to starting getting your application packet together early. Remember, they want to know that you are committed, this is hard to do because your application is due near the beginning of your 4th year.
MRIsatety.com is a great resource for medical students, residents, and all medical personnel. We all know that when a patient has a pacemaker from 2004 that they can not get a thoracic MRI. However, what if the patient had a recent shoulder replacement? What if the patient has a port for chemotherapy? What if the patient had recent spinal surgery? No matter what the circumstance, you can search this website for the patient’s device and find out if it is safe for an MRI.
Have you ever wondered what imaging test should be ordered for your patient? What radiologic test would be most beneficial in this situation? What imaging test should I order first? If a patient comes in with a painful knee, should I get an x-ray or go straight to MRI? If a woman comes in with a non-tender breast mass should I get an ultrasound before the mammogram? These are difficult questions; luckily The American College of Radiology (ACR) has our back! The ACR publishes a fantastic online resource they call the “Appropriateness Criteria” which details the best imaging tests for nearly every presentation.
They website allows the user to choose between a variety of organ systems (e.g. women’s health, urology, gastrointestinal). In each organ system the user can then choose a specific complaint (e.g. breast mass, hematuria, dysphagia). For each complaint, the ACR then allows the user to choose what specific patient presentation is occuring (e.g. 35 year old woman with a new breast mass vs. 35 year old woman with a mass seen on mammogram vs. 70 year old woman with a new breast mass). In each circumstance, the ‘Appropriateness Criteria” explains what is the best radiologic test to help diagnose the patient’s problem. They explain in detail the advantages and disadvantages of each test (MRI, CT scan, ultrasound, x-ray, etc) for each specific problem.
The criteria are updated every few years, the most recent data comes from 2009. One of the best parts about the ACR Appropriateness Criteria can be found at the end of each section. Not only do they make suggestions about which tests will be most useful in diagnosis, they also provide a literature review for EVERY SINGLE patient complaint which outlines what research and studies they are using when making their suggestions.
I HIGHLY RECOMMEND this website. In fact, there are few resources that I can recommend higher. I have used this many times and they intricacies and precision of the criteria still surprise me. There is NO BETTER RESOURCE available to determine which imaging tests are indicated for a specific patient presentation.
My name is Andrew and I am a first year resident training to be an ophthalmologist. I created ShortWhiteCoats to provide medical students, residents, and the public with all the information I spent so many hours looking for during medical school.