Tag Archive: Spotlights: Specialty Choice

Why did you go into Emergency Medicine?


An Emergency Medicine Attending Physician's Perspective:

From an interview with an Emergency Medicine physician in Colorado. 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 Emergency Medicine?

Emergency Medicine is the perfect combination of acuity and generality. I'd like to say that every patient I treat has an emergent reason to be in the ED, but unfortunately, that's not the case.  However, many do.  We evaluate, stabilize, and initiate treatment for critically ill patients every day. We hold difficult discussions with families, provide reassurance to parents, and address a large spectrum of medical illnesses. We are specially-trained to address any potential problem that could walk through the door, be it trauma-related, pediatric, geriatric, or anything in between. 


Describe an emergency department physician's typical work day?

The typical day is quite variable, depending on the day of the week and time of day that you are working.  As emergency physicians, we work in shifts. This means that our work days have predetermined start and end points. While those end points may flex slightly depending on the flow of the department on any given day, and you may be required to stay an hour or so late, when you leave you are done and no longer have to worry yourself about patient care responsibilities. 

I usually arrive 10-15 minutes early for a shift to provide the off-going doctor with a few extra minutes of relief, knowing just how busy his or her day could have been. After signing PA charts and verbal orders from the day before, I get right to seeing patients, or asking around to see if there's anything pending that my partners might need assistance with.  From that point, it's moving from room to room, patient to patient, providing counsel, instruction, reassurance, and at times, bad news. The number of patients seen in a typical shift will vary from day to day, and depending on where you work whether it be a busy urban / suburban ED or a more rural setting, but even in the rural setting any given shift can become incredibly busy; it all depends on the day. 

The hallmark of the emergency physician is the disposition.  At the end of every patient encounter, the patient will either be discharged home, admitted, or transferred.  There are typically no loose ends to worry about or results that will be pending for tomorrow that require attention. Each day brings a new census of patients that will come and go according to their respective disposition, and the cycle repeats itself. 


What type of lifestyle can an Emergency Physician expect?  

As a result of "shift work", the lifestyle of an emergency physician is largely customizable by the individual.  In my group, it's fairly easy to request certain days off for sporting events, school performances, or other special occasions. When those come up unexpectedly, fellow physicians are very accommodating of shift trades. This allows me to be present for my family when I want / need to be. When I'm off during the day, I have time with my wife and young child, and I am home to help with school-aged children, homework, as well as afternoon trips to the park and bike rides, etc. 

Saying that an emergency physician never takes call is a bit of a misnomer; our group does have a back-up call system for unexpected illness, emergency, or even a horrendously busy day in the department when we need an extra person to decompress the waiting room.  I take one 24-hr period of call each month, and find that I very rarely get called in.  Specifically, in the last year I cannot remember being called in, and have only seen 1 or 2 of my partners called in. 

Our group is very equitable about how we disperse shifts.  We do have several dedicated night-docs who take the majority of our night shifts, and the rest are dispersed equally among the rest of us. I work a mixture of shifts, and find that I work on average 14-15 shifts a month (mostly 9 hour shifts), with 4-5 of those being overnights or late evening shifts. This varies by month of course, but on average my number of night shifts is very manageable. 

There will be times when you will have to work nights, weekends, and holidays, but the trade off is time off on weekdays 


What is the potential salary of an Emergency Physician?

Specialty-specific salary information is available from many sources, and this varies by region as well as the collecting agency. The most current numbers from Medscape (http://www.medscape.com/features/slideshow/compensation/2014/emergencymedicine) show a competitive salary averaging at $272,000. It is not unheard of for a partner in a private group to exceed that, but that's the posted average.


What is the job market like for Emergency Medicine?

Honestly, it's great.  You can literally get a job anywhere in the country.  Having said that, not all jobs in EM (or medicine in general) are created equal.  There are certain markets that are more difficult to break into because of a given reason (i.e. mountains, beach, prestigious academic institutions, etc.) but those doors can open by pursuing fellowship training, other post-graduate experience, networking, and sometimes just persistence and demonstrating proficiency above that of your competitors. 


What can you tell us about Emergency Medicine subspecialties?

Post-graduate fellowship training is currently available for Critical Care, EMS, Ultrasound, Administration, Research, Toxicology, Pediatric Emergency Medicine, Disaster medicine, Simulation and Education, Sports Medicine, Health Policy, Emergency Cardiology, International Emergency Medicine and Global Health, Hyperbarics, Legal Medicine, Emergency Neurology, and Wilderness Medicine. 

Most of these are 1 year, some are 2 (CCM, Peds). Salary numbers will vary greatly depending on your chose practice site (private vs Academic, geographic location), and as you subspecialize, your job market narrows significantly (i.e. if you train in Peds and need to work at least part of your shifts in a large children's ED, that limits you geographically), but at the same time some of this post-graduate training can give you quite the edge over other applicants to help you break into more difficult markets. It's all about what you want to build your practice into. For example, if you want to be a toxicology or legal expert, you can likely work in either an academic or private group while still taking call at the poison center / consulting with a malpractice firm. 


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

Every specialty and every job will have some downsides. There are times when dealing with consultants can be challenging, or when patients come to the ED with a chronic problem, sometimes having had a thorough workup, expecting you to be able to solve their problem in an hour or two. You have to be able to take these experiences with a grain of salt, knowing that they will come occasionally, but are greatly outweighed by the opportunity to positively impact both the critical and not-critical (but still ill) patients.

Most people also quote chronic narcotic-seeking patients as a downside. These patients can be challenging as well, but in all reality many emergency departments have policies in place that make this much easier, and you have the backing of your administration and the nurses in the department, making disposition without narcotics on these patients easier.


Editor's Note: For more help choosing a specialty in medicine, I highly recommend one or both of these two great books. I found both very useful.


Interview: The in’s and out’s of radiation oncology

radiation oncology


A Radiation Oncology Attending's Perspective: From an interview with a radiation oncology attending.

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 radiation oncology?

I realized that a radiation oncologist has a unique opportunity to serve as a physician for patients at a very difficult time, and I appreciated the emphasis on shared decision making and communication skill by my mentors in the field. I also enjoyed the emphasis on anatomy and imaging.


  • Describe a radiation oncologist's typical work day?

I typically arrive at around 7am when treatment begins for the day. Most of a radiation oncologist’s work is in an outpatient clinic. The day is spent seeing new consultations, follow-up visits, and evaluating patients who are currently under treatment. When you aren’t seeing patients, your time is usually spent creating individualized radiation treatment plans for new patients, which includes doing a CT simulation, contouring, and planning with a dosimetrist and physicist.


  • What type of lifestyle can a radiation oncologist expect?  

Nearly all of a radiation oncologist’s work is in an outpatient setting, which means that nights, weekends, and holidays are usually free. This is one of the more attractive features of the specialty.


  • What is the potential salary of a radiation oncologist?

The average salary varies significantly between academic settings and private practice. There is a wide variety of compensation agreements depending on each unique situation.


  • What is the job market like for radiation oncology?

Radiation Oncology is a very small field. For example, in some less populous regions, an entire state might have around 16 radiation oncologists. Because of that, it can be challenging to find a job in a specific geographic region. If it is essential for you to live in a certain region, be aware that it might be difficult to make that happen, and that you might have to accept significant compromises to get a job in a given area. This is one of the drawbacks of radiation oncology. If geography and flexible location are important to you, other larger specialties might make for an easier job search (e.g. internal medicine, anesthesiology, etc).


  • What can you tell us about radiation oncology subspecialties?

Most radiation oncologists complete their training after the 5 year residency without doing a fellowship. A fellowship can sometimes help to bolster academic credentials if needed or be used as a segue into a job at a desirable institution. Common fellowships include pediatric radiation oncology and proton therapy.


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

If you have academic aspirations, it can be difficult to find protected time as a radiation oncologist. Geographic limitations are an important consideration (see above).


  • How competitive is the radiation oncology match?

Very. Radiation Oncology attracts students with great boards scores, strong letters of recommendation from mentors, and ample research experience.


  • What must a student do to match well in radiation oncology?

Students must obtain great board scores, demonstrate research productivity, and produce strong letters of support from mentors who know you well.


  • What are residencies looking for in a radiation oncology resident?

Strong credentials will open the door for an interview. Beyond that, programs are looking for someone who can carry on a normal conversation and has a pleasant personality.


  • What should students be looking for in a radiation oncology residency?

It can be interesting to look at where graduates end up after residency. There is a wide variety in the quality of didactics, with most radiation biology and physics courses being something that you just have to endure no matter where you match.


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

While radiation oncology offers a desirable schedule and good compensation, it is important to go into the field for the right reasons. Keep in mind that as a radiation oncologist, you will be taking care of patients who are very ill, and are often approaching the end of life. To be successful, you will need to develop the skill of navigating these sensitive discussions with agility, and sometimes it can be emotionally exhausting. At the same time, helping patients and their families work through these scenarios is very meaningful and fulfilling work.


Editor's Note: For more help choosing a specialty in medicine, I highly recommend one or both of these two great books. I found both very useful.


Spotlight Interview: Why Did You Choose Physical Medicine and Rehabilitation (PM&R)?




A Physical Medicine and Rehabilitation PM&R) Resident’s Perspective: From an interview with a PM&R resident from 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 physical medicine and rehabilitation (PM&R)?

I initially explored PM&R because I always had an interest in neurophysiology and neuroanatomy, and I knew that physiatrists took care of patients with stroke, traumatic brain injury, spinal cord injury, and other disorders of the nervous and musculoskeletal systems. During my first rotation in PM&R was when I learned that physiatrists primary focus in helping their patients is by improving function. This focus on function is ultimately what attracted me to PM&R, because enabling patients with different abilities to function can substantially affect quality of life. Another aspect of PM&R that attracted me to the specialty was working with a multidisciplinary team to provide care. 


  • Describe a physiatrist's typical work day?

The workday of a typical physiatrist is quite regular, usually from about 8am to 5pm, but this can vary somewhat depending on your type of practice. There are many physiatrists who only do outpatient clinic, while others do both inpatient and outpatient. 


  • What type of lifestyle can a physiatrist expect?  

Lifestyle of a physiatrist can be somewhat variable depending on practice setup and location, but overall is considered to be well balanced relative to other specialties in medicine. We also have a high job satisfaction. PM&R is a very family friendly field, with plenty of free time and family time. Most physiatrists do not work nights, but there is some call coverage for those with inpatient duties. On average, call is usually about one week and one weekend per month, but can be less frequent depending on size of the department. Primary (first) call at large hospitals is most often covered by residents and fellows, and the attending is only called when needed. Call does usually include rounding on the weekend, which is usually brief.


  • What is the potential salary of a physiatrist?

The average salary of a physiatrist is around $180,000-190,000. 


  • What is the job market like for PM&R?

The job market for physiatrists is excellent both immediately following completion of residency as well as after advanced fellowship training


  • What can you tell us about PM&R subspecialties?

Another advantage to training in PM&R is that there are many options for subspecialty training. PM&R residents can pursue fellowship in many areas including the following: Interventional Pain/Spine, Sports Medicine, Cancer Rehabilitation, Stroke Rehabilitation, Traumatic Brain Injury, Spinal Cord Injury, Pediatric Rehabilitation Medicine, Neuromuscular Medicine/EMG, Informatics and Research. Most of the clinical fellowships are 1 year of additional training, and Pediatric Rehabilitation Medicine can be 1 year for those who completed a combined residency and 2 years for those who completed a general PM&R residency 


  • What are the potential downsides of PM&R that students should be aware of?

Although I did not consider salary when making my career decisions, it is an important consideration for students to think about as many of us have student loan debt and families to provide for. One potential downside of PM&R that students should be aware of is reimbursement changes for procedures, particularly electrodiagnostic testing. The salary I mentioned earlier is at or just below the average for all physicians.


  • What else would you tell medical students who are considering PM&R?

I highly recommend considering a career in PM&R. It is a fairly small field of medicine but it is growing and evolving, with so many exciting possibilities particularly with advances in technology. Being a physiatrist is incredibly rewarding. It is difficult to describe what it feels like when you see someone who had a stroke, spinal cord injury, or amputation walk again, but it’s pretty awesome to be a part of the team making that happen 


Editor's Note: For more help choosing a specialty in medicine, I highly recommend one or both of these two great books. I found both very useful.


Spotlight Interview: Why did you choose neurosurgery?

vintage neurosurgery

A Neurosurgery Resident’s Perspective: From an interview with a neurosurgical resident from a top program in the Midwest. 

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 neurosurgery?

I knew pretty early on that I enjoyed surgery.  I liked surgery rotations, liked the satisfaction of work that was both mental and physical, liked that there is a lot of instant gratification in surgery, being able to (sometimes) fix something in a very immediate way.  Within surgery I think I could have liked a lot of rotations, but I ultimately gravitated to neurosurgery because I liked seeing people who came in pretty dramatically ill, and sometimes we were able to help, or at least mitigate the badness.  I liked the intensity of it, as well as the variety; there’s everything from tedious microsurgery for brain aneurysms to giant spine cases where you’re using big power tools.  The common denominator is that most of it is pretty high stakes.  


  • Describe a neurosurgeon's typical work day?

In general, days start early and end late.  As a resident I usually get in around 5:30, and the day ends when the cases are over and evening rounds are done.  Sometimes I’m out by 6, but more often substantially later.


  • What type of lifestyle can a neurosurgeon expect?  

Many neurosurgical problems (trauma, ruptured aneurysms, cranial or spine infections) need to be dealt with right away, whether it’s the middle of the night or the weekend.  There are some neurosurgeons that have more regular schedules than others, but most have a substantial amount of call.


  • What is the potential salary of a neurosurgeon?

I honestly don’t know exact numbers, but I do know it is generally high, even for surgical specialties.  I think that shouldn’t factor too much into your decision to go into it though- It’s nice to know you’re going to be well compensated, but I’ve got to think a lot of the long, off-hour, painful cases would be utter misery if your only motivation is that it pays a lot.   


  • What is the job market like for neurosurgery?

I don’t know- I’ll tell you when I’m closer to completing residency!  One thing to be aware of is that in general, private practice docs do more spine surgery, and more of the cranial work is done at Academic Institutions. 


  • What can you tell us about neurosurgery subspecialties?

Subspecialty training after residency can be in pediatrics (1 year fellowship), endovascular or open vascular (1-2 year fellowship), spine (1 year), tumor (1 year), functional (1 year), peripheral nerve (1 year).  


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

A large part of neurosurgery can be trying to help people with chronic pain, and they can be a challenging population.  Neurosurgeons suffer from some of the highest malpractice rates in the country.  There is much discussion in neurosurgical circles about the decreasing reimbursement for our procedures.  Much of patient volume in private practice is spine.  


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

A lot of people say “only do neurosurgery if you couldn’t do anything else.”  I’m not that dogmatic, but you need to realize it’s a pretty heavy lifestyle commitment  


Editor's Note: For more help choosing a specialty in medicine, I highly recommend one or both of these two great books. I found both very useful.


Spotlight Interview: Why Did You Choose ENT?

Neck Dissection

An Otolaryngology (ENT) Resident’s Perspective: From an interview with an ENT resident at from the Midwest.

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 ENT?

I was attracted to surgery initially.  After shadowing in ENT I realize that I really enjoyed the anatomy, I enjoyed the personalities that I encountered in the specialty and I thought that the idea of treating deafness with cochlear implants and the idea of helping kids with cleft lip really exciting.


  • Describe a otolaryngologist’s typical work day?

Work is usually in the office or in the operating room.  Some ENTs split their day between both, but most have "clinic days" and "OR days".  A resident will round in the morning (early like surgery) and either go to the assigned OR or go to the assigned clinic.  Rarely do residents have days to just do floor work after internship.  After the day's work is done residents will finish any consults from the day, round on the patients in the evening and sign out to the covering resident.  

Attendings will typically come in to start their OR or clinic in the morning, check on their patients during the day, and head home when the work is done.


  • What type of lifestyle can a otolaryngologist expect?  

ENT lifestyle is good.  Most ENTs have predictable hours and flexibility to arrange their schedule to avoid working late into the night.  In private practice, ENTs finish by 5 o'clock and their family can count on them to be home.  In academic practice, there can be more evening meetings or emergent consults; and family flexibility is important.  Many ENTs are in academic medicine or practice in private groups and divide call across the group. 


  • What is the potential salary of a otolaryngologist?

$200-300k for someone starting academic job, 400-600k+ for private (Midwest estimates)


  • What is the job market like for otolaryngology?

There seems to be a shortage of ENTs currently and private groups are recruiting heavily across the country.  Academic jobs are available, but may require flexibility on location to get exactly what you are looking for.  Fellowships are generally available, although trends seem to ebb and flow & are unpredictable.  (i.e. recently facial plastics fellowships were very popular: twice as many applicants as positions, but not the case this year (2015))

  • What can you tell us about otolaryngology subspecialties?

Options for otolaryngologists include General ENT, Head and Neck Oncology, Facial Plastics and Reconstructive surgery, Advanced Pediatric Otolaryngology, Laryngology, Rhinology/Allergy, Otology/Neurotology, Skull Base, Surgery, Sleep Medicine.  All differences in salary are mainly determined by private vs. academic setting.

+General ENT- no extra training, most are in private practice with great salary and wide open job market

+Head and Neck oncology- 1-2 year fellowship required, almost all are associated with academic department, most likely type of ENT to have long hours- because surgeries are complex and urgent due to cancer treatment.  Airway and bleeding emergencies happen in the patient population, so call can include overnight emergencies requiring surgery.

+Facial plastics and reconstructive surgery: 1-year fellowship, there is variability within this subspecialty from purely cosmetic facial plastic practice to free flap reconstruction after major cancer surgery.  The lifestyle of the cosmetic surgeon in private practice can be as glamorous as it sounds.  The free flap surgeon lifestyle resembles the head and neck-oncologist.

+Advanced pediatric otolaryngology- 1-2 year fellowship, generally associated with tertiary referral hospital and/or academic center.  Lifestyle is a bit busier because they are more likely to have ICU patients than General ENT counterparts.  Kids are frequently getting things stuck in their trachea at night so call often involves surgery.  

+Laryngology- 1 year fellowship: voice surgery, again typically associated with academic center/tertiary hospital.  Some of these ENTs treat professional vocalists and their practice may resemble the cosmetic (posh) clinic.  Most laryngologists have consistent hours but airway emergencies can be quite stressful.  

+Rhinology/Allergy- 1 year fellowship. Generally specialize in sinus surgery and there is a trend to managing allergy.  May be in private or academic setting.  Lifestyle is good because emergencies are rare- consults can generally wait until office hours.  Somehow billing has been very favorable for rhinology and they are in demand because their practice is lucrative.  

+Otology/Neurotology- 2 year fellowship. Focus on treating ear disease and ear surgery including operations on the internal auditory canal (between the brainstem and the inner ear.)  They are associated with tertiary referral centers/academic centers and have a good lifestyle- consults can generally wait for business hours.  


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

The residency is a surgical residency and that comes with the long hours, pimping, and no service cap.  ENT does not have strong history of research and there are many aspects of treatment which are based on expert opinion as the best evidence.  If you want evidence like cardiology has- it just isn't there yet.  You will encounter snot, ear wax, tracheostomy secretions, pus from neck infections.  If this is unacceptable- stay away.  


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

Many ENT's enjoy all of the gizmos.  Our academic meetings feature many companies coming up with gadgets, scopes and tools for work in the ear/nose/throat.  Robotic surgeries are becoming common in ENT practice.  Minimally invasive surgery is progressing rapidly.  Some of the first applications of 3D printing in medicine have occurred in ENT.  If  you love innovation, look into this specialty.  We have been curing deafness with cochlear implants for decades.  There are many more examples.

There is a big variety within the field and you can perform simple procedures like ear tubes or tonsillectomies- all the way to reconstructing a baby's trachea or removing the voicebox for cancer treatment.  We frequently work alongside other specialities; neurosurgery has overlaps, endocrine surgery with the thyroid and parathyroid glands, oral surgery, ophthalmology, plastic surgery, pediatric surgery, cardiothoracic surgery etc.   

Another strength of the specialty, in my opinion, is that there is no direct medical counterpart (for example neurosurgery and neurology).  Which means that we treat head and neck diseases and we decide when to treat medically and when to treat surgically.  


Editor's Note: For more help choosing a specialty in medicine, I highly recommend one or both of these two great books. I found both very useful.


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 specialty and 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 director 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 (amazon link), there is no better time than intern year. Also, watch the first season of Scrubs where the characters are interns…it is incredibly realistic!



Editor's Note: Applying for residency or preparing for your interviews? I highly recommend First Aid for the Match, The Successful Match: 200 Rules to Succeed in the Residency Match, and The Residency Interview: How To Make the Best Possible Impression .


Spotlight Interview: An Orthopaedic Surgeon’s 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.


  • 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.


  • 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 one or both of these two great books. I found both very useful.


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?



  • 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 one or both of these two great books. I found both very useful.


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 one or both of these two great books. I found both very useful.


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 one or both of these two great books. I found both very useful.


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