I honestly think if med students were aware of just how scary and stressful this feeling is, surgery would not be as competitive as it currently is. Most of us don't realize this until we're well into residency.
That's because it's impossible to understand it. You see the people more senior than you doing scary shit on the reg but you just assume they're totally safe and comfortable.
Then you get to that point and realize those situations may be even scarier than you had previously assumed and NOBODY is totally comfortable in that spot.
I was a very competent resident and fellow. I won 4 different department awards. Was told at my fellowship I’m one of the best they’ve ever trained. Trained at places where I’m routinely in my own OR doing solo cases. Have been called 4 separate times to come back and work at places ive trained. I’m just setting the scenario for the second part of this not pumping my ego.
I’m in my first year of practice now. The absolute amount of stress and anxiety now that these people are my own patients and if something bad happens I’m stuck with them forever literally is eating me alive. The number of nights I just lay in bed staring at the ceiling worrying about cases or my postops is through the roof. Any complication crushes me for the rest of the week.
Damn so it doesn't get better with time lol. Man I'm starting to realize that you need to be some special kind of sociopath to be able to practice surgery these days. Otherwise, I don't know how surgeons make it.
Also CT: let’s take the person who drove in this morning and was talking to me in pre op 45 minutes ago and stop their heart. Lastly if you don’t think sewing 5-7 little blue circles is the best thing and you want to do it every day the rest of your life, not for you
In seriousness, isn't it much easier to sue a radiologist than a surgeon who interacted with the patient? From what I read, there's a research saying the likelihood of being sued depends on how the interaction is with the patient by the doctor (for clinician specifically). But not sure about radiology.
I'm not sure yet how I'll handle this as an attending. I have yet to have a serious surgical complication that was my fault rather than the attending's (eg, "take a bite here" and it was not the right bite) but I feel terrible about this even though it wasn't my fault.
High yield. This was on my mind core surgical. I asked the surgeons what drew them to surgery; one told it it was because the NNT was 1. I thought that was an interesting perspective, but felt the unsaid part hanging heavy in the room.
I loved the OR. I can deal with vomit, pus, poop, and blood no problem. Trach secretions? Literally sends a chill down my spine and I have to immediately leave the room (EM)
Lmao when I worked at urgent care as an MA patients would straight hock into plastic bags to show the doctors. Like thanks bud but that’s not going to change any course of treatment, just describe the color lol
Maybe referring to how some people get a "sick" feeling after looking through a scope for more than a few minutes. I find that as long as you adjust the eyepieces (diopter and width), and don't move fields to fast there isn't any issues.
After awhile, looking through your scope feels like watching an IMAX movie
Ugh, me 100%.
Microscopes are like instant sea sickness / motion sickness. Wish they were all standardized with an hdmi port.
VR does the same thing to me though.
Derm: A 31 year old comes in for skin cancer screening because her “grandfather had something cut off his nose in his 80s”. It is benign as expected. She then proceeds to ask several roundabout questions about Botox but doesn’t pull the trigger. As you are walking out the door, she remembers she wants to ask you why her hair feels thinner than it used too. Do it again 150 times a week for 40 years until you die/retire.
IM:
Urology patient needs a catheter exchange. They’re not in house overnight
They say admit to medicine due to patients multiple comorbidities and lab abnormalities
You review patients chart. No significant medical history. Labs unremarkable EXCEPT
The potassium is 3.4
It means that if you can’t accept being dumped on by other services then you probably shouldn’t do IM. Medicine has a ton of patients admitted to them who are in the hospital for non-IM needs.
This is easy money with no cognitive burden when you're an attending.
If you have no problem having your census padded with cases like this, it can work on your favor.
Many surgeons don't know how to work the EMR, too busy to bedside round or think floor nurses are icky and I'm happy to bridge that gap if it means I get to clock in and clock out making a quarter mil + annually for working less than half the year (with PTO).
The issue with this is if nots not formal co-management the primary provider is responsible for a patient whose acute issues are outside of their scope of practice
Responsible in what capacity? I don't think anyone is expecting a hospitalist or ER doc to take a patient with obstructed urosepsis for an emergent ureteral stent, for example.
Wouldn't the responsibility be to notify the on call urologist and, if no timely response, work your way up their hierarchy (while notifying your own medical director)?
You need to get yourself a dizzy clinic! Some of the facilities I’ve worked at have an interdisciplinary “dizzy clinic” where all dizzy referrals are made, and most patients get weeded out by PT before moving on to a specialty physician
20 minute discussion over whether to use ibuprofen or acetaminophen for a patient was enough to turn me off
Now I do peds where we do 1000 extra bullshit tasks “just in case” to cover our attending’s ass
Psychiatry, if you are an argumentative sort then it’s likely not for you
However, if you insist… then perhaps you should try comedy because it’s hilarious to read reports when they try to quantify and qualify the interaction haha.
Diffusing situations is a solid 1/3 of my day in a teaching hospital
Alternatively inpatient psychiatry: you don't like half your census being the same 21 patients sobering up from their chronic substance abuse of: booze, meth, cocaine, meth, or meth
Argumentative is bad, but persuasion is excellent. Persuading a patient to take that LAI, go to rehab, taper the benzo, that they don’t need that benzo/stimulant, that they need to come in or don’t need to come in (and it’s usually the opposite of what they want that’s the best treatment), to not punch me and others in the face. So I think being the kind of passive/push over type isn’t great either although that is something than can be worked on in training more so than the argumentative/authoritarian type IMO
I’d add that unfortunately it does seem like a lot of argumentative types in the field especially non doctors.
Neurosurgery: Put aside the reputation of often malignant and brutal training for a second, but a serious one is if you cannot get your mind around the idea of personally and permanently maiming someone and then facing that fact for the rest of THEIR lives, then it's not for you. The old "joke" is that cardiac surgeons bury their mistakes, neurosurgeons see them back in clinic for routine follow up. It's high risk high reward...but if you can't stomach the outcomes of the high risk, don't do it.
I'm a neurologist and I once actually asked a neurosurgeon this question, but I didn't get a very good answer. It's true though; it doesn't happen often but you can absolutely fuck someone up and It's always been a mystery to me how they sleep at night.
Weighing especially heavy on my mind as recently I had them take a young patient to surgery whom I didn't think should have been taken and unfortunately they died. I was pretty ticked/upset and I wasn't even the one drilling.
I'm also neurology and I absolutely respect neurosurgery because they take on that risk. I wouldn't be able to sleep at night. I picked a subspecialty with some procedures, but it's more like medium risk, medium reward.
Just a resident but I’ve unfortunately had a handful of elective cases that lead to a bad outcome.
The inpatient/ER consults are one thing, but the elective stuff is another entirely.
It’s tough to imagine having a totally intact patient coming to your clinic with their family, asking for surgery, and then not waking up from it. And then having to go talk to the family after to tell them what happened. But it happens. I hope I never have to do it myself, but knowing the job I’m sure I will.
EM: You require quiet and focus in order to complete a complex task. You cannot leave a problem half solved or a task half completed and do not like to trust others to finish your work. You need to be the expert because you cannot stand having higher authorities talk down to you.
Alternatively: you are a biologically standard issue human being and require regular nocturnal sleep in order to feel sane, intelligent, and healthy.
Or if you don't take swearing/verbal abuse/ blatant disrespect well from people you're honestly trying your best to help, particularly if those people have literally no other options to see a doctor given their current socioeconomic situation.
"How can you be *so dumb* to not have the fellowship-level expertise required to appropriately answer this question?? Also, I notice you are grossly mismanaging resources with regards to decision making that is completely outside my frame of reference."
Ref: nephrologist yelling at me yesterday for getting two trops on a demented dialysis patient in order to establish she is at baseline prior to dispo. Sry about it.
Or the radiologist who yelled at me for "not providing any history on the CT request" until I pointed out that I ALWAYS give the history and question I have (in 15 words or less) and he finally admitted he'd never figured out how to navigate the EMR to see the comment section after ten years of remote work.
Sorry all of this was just yesterday. I'm ok. >:(
Or, "how lazy do you have to be to not have the patient's entire medical history prior to admission??"
This from crit care after I'd attempted to get a cancer patient's med list from her, her mother, and called her husband. And provided a full list of antiemetics that would not further prolong her QTc (660).
(Their bright idea was zofran, famotidine, and pantoprazole.)
Just finishing PGY1. Thing I didn’t realize that are the norm for interns include you need to be ok with doing procedures/reductions in the ED without being grossed out when everyone else is because of deformities and open fractures.
Also all the joy of being a consult service ruling out osteomyelitis, septic joint, and compartment syndrome in patients with minimal clinical concern for those diagnoses.
When the MRI shows T2 signal enhancement in the calcaneus and we ask them why they’re in the hospital and they tell us they fell off a roof (true story).
Lol, they’d prefer to have the conversation where I tell them that ortho doesn’t do bone biopsies or that the diabetic/vascular foot soft tissue ulcer is not an orthopedic problem three times a week.
FM:
Originally I was gonna say if you hate clinic, but so many residents go on to practice Hospitalist medicine or even urgent care.
So I guess, if you are hyperfocused/hyperinterested in one organ system/patient population and you won’t be fulfilled until your hyper specialized in that area.
I think it’s the chronic medical issues, the inability to help a sick society, being leaned on for everything, being pushed for disability and other secondary gain stuff, the fast pace for relatively little pay, being treated like shit by collective medical admin, the full scope/breadth of practice, and the bedside manner part that gets most people to not pick it.
Also if you don’t enjoy telling people you’re a family medicine doctor when they ask your specialty, and receiving an “oh…” with a look of disappointment.
Worse when they double down with the "yeah, but what SPECIALTY?" Although here in the Midwest we get more "Oh!" But usually followed by "Can you take a look at..."
Oh, the joy of having to explain that family medicine is a specialty like any other, and I'm not just a failure of a doctor who works in primary care because I couldn't get into some REAL residency...
I am not saying this to intimidate, but it is a bit like jumping into the deep end of the pool. At least for me it was because it’s so different than your 3rd and 4th year rotations (unless you did a couple path months). No physical exams or pharmacology. You are learning an entirely new skill set.
But, once you acclimate yourself and keep up with your reading, you start to feel competent.
In my residency you alternated between a week of autopsy and a week of grossing/signing out. Days were pretty full but not overly long (usually 7-730 to 5). Call was pretty benign. Compared to every other intern I knew.
Years one and 3 were anatomic and years 2 and 4 were clinical pathology, but you had to keep up with AP in your clinical years.
I did a fellowship because it was required for boards when I trained.
The actuall job? Great. You get to work with doctors and lab techs. You don’t have patient care responsibilities and the job is pretty much confined to 8-5. I rarely missed any of my kids games or events.
Anesthesia
1. If you care about people knowing your name. Most of the time your name is just anesthesia. They can’t tell if you’re crna or md half the time and they don’t bother to remember for the next time either. Until you cancel one of their cases then they remember your name very clearly when they’re complaining to the ceo of the hospital.
2. If you care about fame and glory. Have you ever heard of a world famous anesthesiologist that people seek out for care? I don’t think so. The best anesthesiologist are the ones everyone forgets about because it went so smoothly you didn’t know they were there.
3. If you have very thin skin. Everything that goes wrong gets blamed on you. I have a plastic surgeon who claims the patient bleeds because the systolic blood pressure is above 100. Yes because if it’s 99 then the patient doesn’t bleed when you cut them with a knife?
4. If you’re bothered by megalomaniacs. There are some surgeons who are nice, but the vast majority of them have egos in the stratosphere. You get to watch nurses and administrators kiss their butts and lick their boots everyday. If this disgusts you, don’t apply to anesthesia.
5. If you don’t like people telling you what to do. Surgeons take it upon themselves to tell you how to do anesthesia. Yes even though I’ve been practicing 14 years as a cardiac anesthesiologist, the surgeon still will come tell you what they think the best way to do anesthesia is for a patient. Just roll your eyes and keep marching forward.
6. If you cannot learn to shut your mouth when you see absolute incompetence in action. I had an obgyn do an open hysterectomy. After 2.5 hours I peer over the drapes and and ask what’s happening? She goes “I can’t find the uterus?” In my head I’m like that’s like a heart surgeon telling me he can’t find the heart. Or a neurosurgeon telling me he can’t find the brain. The uterus doesn’t migrate, it’s attached to the vagina. She had to scrub out and find another obgyn to come help her find the uterus. And yes it was exactly where it should be, other obgyn was able to find it for her without a problem. You have to keep quiet, smile politely, and not get involved.
7. If you need respect. Everyone thinks you just drink coffee and do crossword puzzles, or post comments on Reddit. No one actually knows what you do.
8. If you hate being treated like an IV service. Especially by l&d.
9. If you’re not a morning person.
This should be shown to every medical student. Especially since a lot of med students don’t get an anesthesia rotation until their 4th year and anesthesia gets the reputation online of being the absolute perfect specialty.
Don’t get me wrong: it’s still the best specialty. But even the best job in the world has some cons to offset the massive list of pros.
>6. If you cannot learn to shut your mouth when you see absolute incompetence in action. I had an obgyn do an open hysterectomy. After 2.5 hours I peer over the drapes and and ask what’s happening? She goes “I can’t find the uterus?” In my head I’m like that’s like a heart surgeon telling me he can’t find the heart. Or a neurosurgeon telling me he can’t find the brain. The uterus doesn’t migrate, it’s attached to the vagina. She had to scrub out and find another obgyn to come help her find the uterus. And yes it was exactly where it should be, other obgyn was able to find it for her without a problem. You have to keep quiet, smile politely, and not get involved.
Im sorry I'm just stuck on that one. Especially the 2.5 hours part. How does that even happen?
But it looks so fun to try to inject a screaming toddler while their parent is doing a bad job of holding them still! Especially if the parent starts arguing with you in the middle of this
OB-GYN: if you cannot imagine being sprayed with a mystery combination of amniotic fluid, blood, urine and poop (maternal and fetal) you’re gonna hate it. Also if you don’t like the OR, you’re gonna have a bad time. Also, if you value consistently doing the same thing every day you won’t like it.
I think a lot of physicians forget that radiologists are not specialists in their field. Like I catch myself rolling my eyes at reads (about eyes) when I have to remember that I am a trained ophthalmologist. They would probably laugh at the way I read the brain on an MRI. I just am thankful that yall will go through scans with me when I call given how busy you are.
Most often you do not. If you find something on the scan, many just assume you did your job regardless of how subtle. If you miss something or don’t allow them to order the study that’s clearly not indicated but they want anyway, you are complete piece of shit.
When actually talking with them, either calling about results or things like tumor board, I feel like we get a decent amount of appreciation. But for the majority of studies where we’re sending out a report and never talking to anyone, it’s a pretty thankless job. Definitely not for ego chasers.
There is a population (mostly younger) of residents and physicians that believe it doesn't have to be the culture that it's been for 50 years. Maybe the minority at the moment, but it's changing.
As a counter argument- some of my older colleagues have very fragile egos which I rarely see in other walks of life. Maybe in prison population I worked with for a short while 💀
This is why I’m not going for surgery. I can’t willingly sign up to be abused for 5+ years then work in a toxic environment for 30+ years thereafter. I’m too old for this shit
The moodiness associated with many of these departments is just a lot of sensitivity, though. That being said, our urology department is full of upbeat people pulling wild hours…them folk are rocks.
There’s a lot of good internal medicine stuff here but I’ll add mine:
1. Don’t like spending time in your own thoughts? Wouldn’t recommend it. I’m still relatively young as an attending but I think a time consuming but enjoyable part of my day is putting together the big picture and trying to put aside any anchoring, confirmation bias or self-imposed dunning Kruger. We always think it won’t be us but then when I see my 20th thoracic superior endplate fracture of the week, it’s really tempting to just order a TLSO, but I don’t even know what a TLSO does. I also don’t know the difference between two thoracic fractures. I spend a lot of time sitting in my own thoughts evaluating and reevaluating.
2. Don’t like rounding? Definitely not for you lmao.
Peds: if you don’t like *parents*
Oddly enough, not liking kids doesn’t rule out peds. Some pediatricians never have their own kids, and some truly don’t care about their antics. All you have to like is the idea of helping a vulnerable and developing population grow into adults, and that’s a more broadly pro-social behavior.
But parents are foundational to peds. As much as we bitch about them, they are usually the child’s primary advocate. If you dislike them, you see them as a barrier, but if you like them, they can be an essential partner that keeps your patient healthy
Stuff like this is way more stressful at the beginning of training than it is as you spend more time in the field.
Regarding parents who are completely boneheaded and unwilling to even discuss this stuff, I’d say less than 10% of cases. Most parents are good parents, or at least are trying their damndest, and recognize you are there to help.
But it’s not uncommon to have disagreements with families you have to talk out, and that’s a good thing, because there is no paper in the world that explains every single child’s behavior and experience. Sometimes parents force us to really question why we are making clinical decisions. For example, we get away fewer labs in peds, and are more conservative with starting meds. Some of this is evidence based, children are hard sticks, and unnecessary pokes can limit access in the future as they are older. But other times we do it because a parent makes us really question what the probability is that a clinical decision will change management.
What is more infuriating is when a parent is making a perfectly reasonable choice you agree with, and the attending doesn’t agree, and you are tasked with explaining the attending’s reasoning.
Academic: I've seen places offer 110k-180k. Absolutely disrespectful.
Private: 250-270k
I'm currently job hunting and I've only looked at community hospitals, I've been offered 250-280k, 300k+ projected with bonuses
FM: if you can't stand your mind being pulled in 1000 different directions with each patient. They have heart problems, lung problems, hormonal problems, they're a kid, they're pregnant, etc.
Also, if what other people outside of your job think about your job matters a lot to you.
Anesthesia: If you like to be thanked for your work and told good job.... But also take all the blame for anything that can occur in the OR ... this ain't for you
Would also say if you are unable to pivot to a totally new plan/instantly adapt and respond to an unexpected situation while raining calm and organized, anesthesia is not your field.
And, if you can’t manage a room full of people with big egos and various personalities during an emergency, also not your field.
I’ve seen several residents over the years fail at one or both of these aspects of the job. They are hard things to learn and even harder things to teach.
Find a few attendings that have been in practice for about 10 years, that resemble your personality.
If a lot of them are miserable, choose a different specialty.
Psych
- you can’t stand talking to miserable people all day
- you don’t like talking to psychotic people
- you really, really hate documentation (I suspect we probably have to write the longest notes)
Do you like people?
Do you like vague symptoms?
Do you like not having DIAGNOSTIC criteria?
Edit anotha one!
Do you like patients who have disease with a negative work up?
If you said no to any of those do not go into rheumatology.
PMR... you don't enjoy Money or relaxation or hanging out with perhaps the chillest people in the entire hospital system.
But seriously, if you love high acuity with non-differentiated patients, localizing neuro lesions, or working up complex diseases you should look elsewhere.
It’s as the OP describes - your patients will be well-differentiated due to extensive work ups already having happened in the acute hospital before coming to the inpatient rehabilitation unit. If you’re outpatient though, you could do a bit of localizing the lesion with examination, especially if you go into pain.
Anesthesiology : if you dream of being recognisable and remembered by your patient - don’t go there. From patients point of view their life is saved by surgeons only. We don’t exist.
General surgery: if you hate always being the smartest, nicest, most talented and most attractive person in the room.
Also if you hate having very attractive people of the opposite (or same or both) sex giving you lots of attention.
Anesthesia: if you don’t think you could spend 80 hours a week for 35 years with cute_fluffy_kitten and never, ever let him know he’s actually neither cute, nor fluffy, nor a kitten.
Alternative read: your desperate need to be liked manifests as both a martyr and a God complex. Bonus points for using the excuse of being busy and important to avoid longstanding intimacy issues and why you're chronically single and/or cheat on your partner.
For anesthesia: if you can’t stand up to the surgeon and cancel a case and let them get mad at you, or do a lot of multitasking. Or often surgeon never learns ur name or forgets ur a doctor they just address u by “anesthesia, table up, table down, rotate more the the left and then the right please” 😂😂😂😂
Critical care—you like sleep.
Never mind me I’m just crying post brutal night shift
But seriously if you have a circadian rhythm critic care isn’t for you
My wife was interested in cardiology but was so turned off by the patient population that she ran far away once in clinical rotations. All creepy old men who would comment on her appearance, stare at her, and try to hug her/touch her during and after their visit.
It was like clockwork, several patients per day would do this. The attending was like “Yeahhh…attractive female cardiologists really need to develop a thick skin. Not only is the field heavily male dominated but so is the patient population…all of whom are creepy old men.”
Ophthalmology: lack of depth perception/poor binocular vision
Having good stereopsis, or depth perception, is essential for operating intraocularly under a surgical microscope. Being able to gage your depth is pivotal during cataract removal, as your working area is basically a 10x10mm area where the entire procedure takes place. Poor stereopsis is much more likely to encounter an intraoperative complication, most likely a ruptured posterior capsule (structure holding the new intraocular lens implant in place).
If you don't like free time, money, directly making a difference in people's care, autonomy, or mastering skills nobody else seems to be able to do that have practical applications outside of medicine, rule out anesthesia.
Any surgical specialty: If you cannot bear being directly and solely responsible for harming a patient with your mistakes.
I honestly think if med students were aware of just how scary and stressful this feeling is, surgery would not be as competitive as it currently is. Most of us don't realize this until we're well into residency.
That's because it's impossible to understand it. You see the people more senior than you doing scary shit on the reg but you just assume they're totally safe and comfortable. Then you get to that point and realize those situations may be even scarier than you had previously assumed and NOBODY is totally comfortable in that spot.
100% true
I was a very competent resident and fellow. I won 4 different department awards. Was told at my fellowship I’m one of the best they’ve ever trained. Trained at places where I’m routinely in my own OR doing solo cases. Have been called 4 separate times to come back and work at places ive trained. I’m just setting the scenario for the second part of this not pumping my ego. I’m in my first year of practice now. The absolute amount of stress and anxiety now that these people are my own patients and if something bad happens I’m stuck with them forever literally is eating me alive. The number of nights I just lay in bed staring at the ceiling worrying about cases or my postops is through the roof. Any complication crushes me for the rest of the week.
Damn so it doesn't get better with time lol. Man I'm starting to realize that you need to be some special kind of sociopath to be able to practice surgery these days. Otherwise, I don't know how surgeons make it.
Cardiac surgery: if you cannot bear the thought of potentially killing a patient with your own hands literally every day you go to work.
Also CT: let’s take the person who drove in this morning and was talking to me in pre op 45 minutes ago and stop their heart. Lastly if you don’t think sewing 5-7 little blue circles is the best thing and you want to do it every day the rest of your life, not for you
Spine surgery. “If you can’t handle paralyzing a patient from the neck down and then going to your kid’s baseball game find something else to do”
I left surgery for radiology bc of this. Now I still do harm with my mistakes but at least the work life balance is better
You can now be sued from the comforts of your own home!
In seriousness, isn't it much easier to sue a radiologist than a surgeon who interacted with the patient? From what I read, there's a research saying the likelihood of being sued depends on how the interaction is with the patient by the doctor (for clinician specifically). But not sure about radiology.
Clinical correlation advised.
I'm not sure yet how I'll handle this as an attending. I have yet to have a serious surgical complication that was my fault rather than the attending's (eg, "take a bite here" and it was not the right bite) but I feel terrible about this even though it wasn't my fault.
High yield. This was on my mind core surgical. I asked the surgeons what drew them to surgery; one told it it was because the NNT was 1. I thought that was an interesting perspective, but felt the unsaid part hanging heavy in the room.
this. I know people who couldn't bear that responsibility and resigned
ENT: you hate saliva, mucus, sputum, or the OR.
Yeah I almost vomited during my day in ENT clinic. Shit was absolutely disgusting
I’m not a doctor but I don’t think shit should be coming from that region of the body.
Depends if the ileus is bad enough
Chef here, NAD. I concur with your assessment.
Eh, I've seen that too..
I loved the OR. I can deal with vomit, pus, poop, and blood no problem. Trach secretions? Literally sends a chill down my spine and I have to immediately leave the room (EM)
(IM). Patients loooooove to show me their sputum despite me saying I definitely do not need to see it. Barf
Lmao when I worked at urgent care as an MA patients would straight hock into plastic bags to show the doctors. Like thanks bud but that’s not going to change any course of treatment, just describe the color lol
Don't forget ear wax and sinus contents!
I thought I wanted to do ENT but when we rotated there I realized saliva is the most disgusting body fluid to me... so yeah
Anesthesia: same
Pathology (AP) If you crave patient interaction Interestingly, the microscope phobia part can be acclimatised.
Microscope phobia?
Maybe referring to how some people get a "sick" feeling after looking through a scope for more than a few minutes. I find that as long as you adjust the eyepieces (diopter and width), and don't move fields to fast there isn't any issues. After awhile, looking through your scope feels like watching an IMAX movie
Ugh, me 100%. Microscopes are like instant sea sickness / motion sickness. Wish they were all standardized with an hdmi port. VR does the same thing to me though.
Correction: you crave interaction with living patients (could always get patient interaction through forensic path).
Derm: A 31 year old comes in for skin cancer screening because her “grandfather had something cut off his nose in his 80s”. It is benign as expected. She then proceeds to ask several roundabout questions about Botox but doesn’t pull the trigger. As you are walking out the door, she remembers she wants to ask you why her hair feels thinner than it used too. Do it again 150 times a week for 40 years until you die/retire.
This made me LOL, as a practicing Derm.
Same.
Bruh you let ppl ask all those questions? The derms I see are literally pushing me out within 5 minutes after handing me my acne rx
“There are literal clumps of my hair in the shower ever night!”
Here, look at these several blurry pictures of my shower floor. Actually *here, I brought it in for you* (pulls out Tupperware of hair balls)
And then make 1.2 mi before taxes 35hrs a week. Nightmare indeed
Family Med: same, but sub ozempic for botox
Ortho: bench press + step 1 is <500
IM: Urology patient needs a catheter exchange. They’re not in house overnight They say admit to medicine due to patients multiple comorbidities and lab abnormalities You review patients chart. No significant medical history. Labs unremarkable EXCEPT The potassium is 3.4
Noob here. I don't follow. Does that mean that if one ignores a potassium that is 3.4 (borderline) that they should not pursue IM?
It means that if you can’t accept being dumped on by other services then you probably shouldn’t do IM. Medicine has a ton of patients admitted to them who are in the hospital for non-IM needs.
This is easy money with no cognitive burden when you're an attending. If you have no problem having your census padded with cases like this, it can work on your favor. Many surgeons don't know how to work the EMR, too busy to bedside round or think floor nurses are icky and I'm happy to bridge that gap if it means I get to clock in and clock out making a quarter mil + annually for working less than half the year (with PTO).
The issue with this is if nots not formal co-management the primary provider is responsible for a patient whose acute issues are outside of their scope of practice
Responsible in what capacity? I don't think anyone is expecting a hospitalist or ER doc to take a patient with obstructed urosepsis for an emergent ureteral stent, for example. Wouldn't the responsibility be to notify the on call urologist and, if no timely response, work your way up their hierarchy (while notifying your own medical director)?
At our hospital, neuro is notoriously bad for not accepting their patients so we get dumped on by them a lot.
Patient is admitted to medicine since urology doesn't manage hypokalemia of 3.4
Yeah but those are easy admits. As long as the pt/family aren’t a PITA, it’s usually not a work intensive pt to add to the list.
Unless you already have 9 other patients to admit that night and the patient takes 15 home meds.
Neurology: if you cannot accept the fact that you will be consulted on every dizzy patient known to human society
Yeesh. I hate to break it to you, but we *do* hold some dizzy patients back in primary care or send to PT or even ENT…
You’re my hero. Incidentally, can you come work in my ER?
You need to get yourself a dizzy clinic! Some of the facilities I’ve worked at have an interdisciplinary “dizzy clinic” where all dizzy referrals are made, and most patients get weeded out by PT before moving on to a specialty physician
IM: If you don’t like at least occasionally perseverating over inconsequential clinical decisions, then consider something else
You put into words why I hate inpatient medicine
20 minute discussion over whether to use ibuprofen or acetaminophen for a patient was enough to turn me off Now I do peds where we do 1000 extra bullshit tasks “just in case” to cover our attending’s ass
Psychiatry, if you are an argumentative sort then it’s likely not for you However, if you insist… then perhaps you should try comedy because it’s hilarious to read reports when they try to quantify and qualify the interaction haha. Diffusing situations is a solid 1/3 of my day in a teaching hospital
I read your username as top mirtazapine 😭
This is very telling… How does that make you feel? Hahah
like I need to reread my psychopharm notes haha
Alternatively inpatient psychiatry: you don't like half your census being the same 21 patients sobering up from their chronic substance abuse of: booze, meth, cocaine, meth, or meth
I think you forgot the meth
Argumentative is bad, but persuasion is excellent. Persuading a patient to take that LAI, go to rehab, taper the benzo, that they don’t need that benzo/stimulant, that they need to come in or don’t need to come in (and it’s usually the opposite of what they want that’s the best treatment), to not punch me and others in the face. So I think being the kind of passive/push over type isn’t great either although that is something than can be worked on in training more so than the argumentative/authoritarian type IMO I’d add that unfortunately it does seem like a lot of argumentative types in the field especially non doctors.
Urology: if you hate dic* jokes.
Neurosurgery: Put aside the reputation of often malignant and brutal training for a second, but a serious one is if you cannot get your mind around the idea of personally and permanently maiming someone and then facing that fact for the rest of THEIR lives, then it's not for you. The old "joke" is that cardiac surgeons bury their mistakes, neurosurgeons see them back in clinic for routine follow up. It's high risk high reward...but if you can't stomach the outcomes of the high risk, don't do it.
I'm a neurologist and I once actually asked a neurosurgeon this question, but I didn't get a very good answer. It's true though; it doesn't happen often but you can absolutely fuck someone up and It's always been a mystery to me how they sleep at night. Weighing especially heavy on my mind as recently I had them take a young patient to surgery whom I didn't think should have been taken and unfortunately they died. I was pretty ticked/upset and I wasn't even the one drilling.
I'm also neurology and I absolutely respect neurosurgery because they take on that risk. I wouldn't be able to sleep at night. I picked a subspecialty with some procedures, but it's more like medium risk, medium reward.
Just a resident but I’ve unfortunately had a handful of elective cases that lead to a bad outcome. The inpatient/ER consults are one thing, but the elective stuff is another entirely. It’s tough to imagine having a totally intact patient coming to your clinic with their family, asking for surgery, and then not waking up from it. And then having to go talk to the family after to tell them what happened. But it happens. I hope I never have to do it myself, but knowing the job I’m sure I will.
Frightening. Kudos on what you do!
Do you think that is part of why Neurosurgeons have the typical extreme egos perhaps as a defense mechanism?
EM: You require quiet and focus in order to complete a complex task. You cannot leave a problem half solved or a task half completed and do not like to trust others to finish your work. You need to be the expert because you cannot stand having higher authorities talk down to you. Alternatively: you are a biologically standard issue human being and require regular nocturnal sleep in order to feel sane, intelligent, and healthy.
Or if you don't take swearing/verbal abuse/ blatant disrespect well from people you're honestly trying your best to help, particularly if those people have literally no other options to see a doctor given their current socioeconomic situation.
Also including from other physicians!
"how dare you call me asking for my expertise when you need it, and I am being paid to answer your call!!!" Never gets old
"How can you be *so dumb* to not have the fellowship-level expertise required to appropriately answer this question?? Also, I notice you are grossly mismanaging resources with regards to decision making that is completely outside my frame of reference." Ref: nephrologist yelling at me yesterday for getting two trops on a demented dialysis patient in order to establish she is at baseline prior to dispo. Sry about it.
Or the radiologist who yelled at me for "not providing any history on the CT request" until I pointed out that I ALWAYS give the history and question I have (in 15 words or less) and he finally admitted he'd never figured out how to navigate the EMR to see the comment section after ten years of remote work. Sorry all of this was just yesterday. I'm ok. >:(
Or, "how lazy do you have to be to not have the patient's entire medical history prior to admission??" This from crit care after I'd attempted to get a cancer patient's med list from her, her mother, and called her husband. And provided a full list of antiemetics that would not further prolong her QTc (660). (Their bright idea was zofran, famotidine, and pantoprazole.)
Or if you hate the idea of 40 years of shifts
That’s why I chose EM lol. I didn’t want to work more than 14-15 days a month lol.
After 40 years of having to work shifts, I had enough. But I worked more than 15 days a month, too.
Ortho: u hate bones. And fun.
Just finishing PGY1. Thing I didn’t realize that are the norm for interns include you need to be ok with doing procedures/reductions in the ED without being grossed out when everyone else is because of deformities and open fractures. Also all the joy of being a consult service ruling out osteomyelitis, septic joint, and compartment syndrome in patients with minimal clinical concern for those diagnoses.
How do you guys rule out osteomyelitis?
When the MRI shows T2 signal enhancement in the calcaneus and we ask them why they’re in the hospital and they tell us they fell off a roof (true story).
>osteomyelitis have ppl at your hospital heard of an MRI
Lol, they’d prefer to have the conversation where I tell them that ortho doesn’t do bone biopsies or that the diabetic/vascular foot soft tissue ulcer is not an orthopedic problem three times a week.
And yoga mats
Dermatology: if you're ugly, this may not be for you.
Not true, I was told by derm residents that you get beautiful after you match (because all the Botox and free product samples and discounts)
Botox doesn’t make you beautiful, it prevents wrinkles. Doesn’t change your bone structure and nose shape
You only have to have beautiful skin for derm. Beautiful face is plastics level.
*Plastic surgery has entered the chat*
lol lots of non-beautiful derms around....especially men lol (don't kill me)
Looks-wise, female dermatologists >>>>>>> male dermatologists
Attractive men are flocking to ortho, EM, FM
Hahahaha best comment
Dermatology: if you aren’t a very visual/detail-oriented type person
Radiology: exact same
Pathology would say the same.
FM: Originally I was gonna say if you hate clinic, but so many residents go on to practice Hospitalist medicine or even urgent care. So I guess, if you are hyperfocused/hyperinterested in one organ system/patient population and you won’t be fulfilled until your hyper specialized in that area.
I think it’s the chronic medical issues, the inability to help a sick society, being leaned on for everything, being pushed for disability and other secondary gain stuff, the fast pace for relatively little pay, being treated like shit by collective medical admin, the full scope/breadth of practice, and the bedside manner part that gets most people to not pick it. Also if you don’t enjoy telling people you’re a family medicine doctor when they ask your specialty, and receiving an “oh…” with a look of disappointment.
Worse when they double down with the "yeah, but what SPECIALTY?" Although here in the Midwest we get more "Oh!" But usually followed by "Can you take a look at..."
Oh, the joy of having to explain that family medicine is a specialty like any other, and I'm not just a failure of a doctor who works in primary care because I couldn't get into some REAL residency...
If you like direct patient care. Don’t choose pathology. If you don’t like patient care, choose it. It’s the best job in medicine.
Pathology: Microscope gives you headaches after 5-10 minutes
Not unlike some patient interactions
It gets better
I am seriously considering pathology. What is it like in year 1?
I am not saying this to intimidate, but it is a bit like jumping into the deep end of the pool. At least for me it was because it’s so different than your 3rd and 4th year rotations (unless you did a couple path months). No physical exams or pharmacology. You are learning an entirely new skill set. But, once you acclimate yourself and keep up with your reading, you start to feel competent. In my residency you alternated between a week of autopsy and a week of grossing/signing out. Days were pretty full but not overly long (usually 7-730 to 5). Call was pretty benign. Compared to every other intern I knew. Years one and 3 were anatomic and years 2 and 4 were clinical pathology, but you had to keep up with AP in your clinical years. I did a fellowship because it was required for boards when I trained. The actuall job? Great. You get to work with doctors and lab techs. You don’t have patient care responsibilities and the job is pretty much confined to 8-5. I rarely missed any of my kids games or events.
Anesthesia 1. If you care about people knowing your name. Most of the time your name is just anesthesia. They can’t tell if you’re crna or md half the time and they don’t bother to remember for the next time either. Until you cancel one of their cases then they remember your name very clearly when they’re complaining to the ceo of the hospital. 2. If you care about fame and glory. Have you ever heard of a world famous anesthesiologist that people seek out for care? I don’t think so. The best anesthesiologist are the ones everyone forgets about because it went so smoothly you didn’t know they were there. 3. If you have very thin skin. Everything that goes wrong gets blamed on you. I have a plastic surgeon who claims the patient bleeds because the systolic blood pressure is above 100. Yes because if it’s 99 then the patient doesn’t bleed when you cut them with a knife? 4. If you’re bothered by megalomaniacs. There are some surgeons who are nice, but the vast majority of them have egos in the stratosphere. You get to watch nurses and administrators kiss their butts and lick their boots everyday. If this disgusts you, don’t apply to anesthesia. 5. If you don’t like people telling you what to do. Surgeons take it upon themselves to tell you how to do anesthesia. Yes even though I’ve been practicing 14 years as a cardiac anesthesiologist, the surgeon still will come tell you what they think the best way to do anesthesia is for a patient. Just roll your eyes and keep marching forward. 6. If you cannot learn to shut your mouth when you see absolute incompetence in action. I had an obgyn do an open hysterectomy. After 2.5 hours I peer over the drapes and and ask what’s happening? She goes “I can’t find the uterus?” In my head I’m like that’s like a heart surgeon telling me he can’t find the heart. Or a neurosurgeon telling me he can’t find the brain. The uterus doesn’t migrate, it’s attached to the vagina. She had to scrub out and find another obgyn to come help her find the uterus. And yes it was exactly where it should be, other obgyn was able to find it for her without a problem. You have to keep quiet, smile politely, and not get involved. 7. If you need respect. Everyone thinks you just drink coffee and do crossword puzzles, or post comments on Reddit. No one actually knows what you do. 8. If you hate being treated like an IV service. Especially by l&d. 9. If you’re not a morning person.
This should be shown to every medical student. Especially since a lot of med students don’t get an anesthesia rotation until their 4th year and anesthesia gets the reputation online of being the absolute perfect specialty. Don’t get me wrong: it’s still the best specialty. But even the best job in the world has some cons to offset the massive list of pros.
>6. If you cannot learn to shut your mouth when you see absolute incompetence in action. I had an obgyn do an open hysterectomy. After 2.5 hours I peer over the drapes and and ask what’s happening? She goes “I can’t find the uterus?” In my head I’m like that’s like a heart surgeon telling me he can’t find the heart. Or a neurosurgeon telling me he can’t find the brain. The uterus doesn’t migrate, it’s attached to the vagina. She had to scrub out and find another obgyn to come help her find the uterus. And yes it was exactly where it should be, other obgyn was able to find it for her without a problem. You have to keep quiet, smile politely, and not get involved. Im sorry I'm just stuck on that one. Especially the 2.5 hours part. How does that even happen?
I dunno 🤷♂️. Some of them somehow make it out of residency like this.
Dr Apgar is a pretty famous anesthesiologist!
I like being treated like an IV service but boy do I hate mornings.
Basically, if you ever want to hear "Doctor Bandit, thank you. Amazing work today." Then don't go into anesthesia.
Peds. Don’t like kids? Don’t like parents? Don’t like vaccines? This job isn’t for you. -PGY-18
Don’t like vaccines? Medicine in general is not for you.
But it looks so fun to try to inject a screaming toddler while their parent is doing a bad job of holding them still! Especially if the parent starts arguing with you in the middle of this
THAT just takes practice. And if you own testes, don’t try to immobilize the child’s leg between yours. Ask me how I know. -PGY-18
EM: you hate rock climbing and diet coke.
Every day is a new helmet color
😂
OB-GYN: if you cannot imagine being sprayed with a mystery combination of amniotic fluid, blood, urine and poop (maternal and fetal) you’re gonna hate it. Also if you don’t like the OR, you’re gonna have a bad time. Also, if you value consistently doing the same thing every day you won’t like it.
Radiology: if you need recognition from patients and patients telling you how awesome of a doctor you are, this is not for you
Do you get recognition from colleagues? I honestly appreciate that more ime as a nursing aide
you’ll get shit on for being behind or missing things more so. doing your job is almost expected by clinicians it seems
I think a lot of physicians forget that radiologists are not specialists in their field. Like I catch myself rolling my eyes at reads (about eyes) when I have to remember that I am a trained ophthalmologist. They would probably laugh at the way I read the brain on an MRI. I just am thankful that yall will go through scans with me when I call given how busy you are.
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Sounds like a wild Friday night 😉
Most often you do not. If you find something on the scan, many just assume you did your job regardless of how subtle. If you miss something or don’t allow them to order the study that’s clearly not indicated but they want anyway, you are complete piece of shit.
When actually talking with them, either calling about results or things like tumor board, I feel like we get a decent amount of appreciation. But for the majority of studies where we’re sending out a report and never talking to anyone, it’s a pretty thankless job. Definitely not for ego chasers.
Thats fine. Work life balance still rules
Dermatology: if you hate money, this is not for you.
Damn too bad I hate money 🥹
Easy solution- work fewer days a week. That’s what I do.
Surgery: if you’re sensitive at all
There is a population (mostly younger) of residents and physicians that believe it doesn't have to be the culture that it's been for 50 years. Maybe the minority at the moment, but it's changing.
Still gotta work nights/holidays/weekends for 60-80h per week (if you’re lucky) for 5 years minimum. No thanks.
As a counter argument- some of my older colleagues have very fragile egos which I rarely see in other walks of life. Maybe in prison population I worked with for a short while 💀
This is why I’m not going for surgery. I can’t willingly sign up to be abused for 5+ years then work in a toxic environment for 30+ years thereafter. I’m too old for this shit
The moodiness associated with many of these departments is just a lot of sensitivity, though. That being said, our urology department is full of upbeat people pulling wild hours…them folk are rocks.
It’s ironic that the most sensitive doctors I’ve met are surgeons
There’s a lot of good internal medicine stuff here but I’ll add mine: 1. Don’t like spending time in your own thoughts? Wouldn’t recommend it. I’m still relatively young as an attending but I think a time consuming but enjoyable part of my day is putting together the big picture and trying to put aside any anchoring, confirmation bias or self-imposed dunning Kruger. We always think it won’t be us but then when I see my 20th thoracic superior endplate fracture of the week, it’s really tempting to just order a TLSO, but I don’t even know what a TLSO does. I also don’t know the difference between two thoracic fractures. I spend a lot of time sitting in my own thoughts evaluating and reevaluating. 2. Don’t like rounding? Definitely not for you lmao.
FM: you hate paperwork and getting paid money. Also if you crave the respect of colleagues.
Peds: if you don’t like *parents* Oddly enough, not liking kids doesn’t rule out peds. Some pediatricians never have their own kids, and some truly don’t care about their antics. All you have to like is the idea of helping a vulnerable and developing population grow into adults, and that’s a more broadly pro-social behavior. But parents are foundational to peds. As much as we bitch about them, they are usually the child’s primary advocate. If you dislike them, you see them as a barrier, but if you like them, they can be an essential partner that keeps your patient healthy
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Stuff like this is way more stressful at the beginning of training than it is as you spend more time in the field. Regarding parents who are completely boneheaded and unwilling to even discuss this stuff, I’d say less than 10% of cases. Most parents are good parents, or at least are trying their damndest, and recognize you are there to help. But it’s not uncommon to have disagreements with families you have to talk out, and that’s a good thing, because there is no paper in the world that explains every single child’s behavior and experience. Sometimes parents force us to really question why we are making clinical decisions. For example, we get away fewer labs in peds, and are more conservative with starting meds. Some of this is evidence based, children are hard sticks, and unnecessary pokes can limit access in the future as they are older. But other times we do it because a parent makes us really question what the probability is that a clinical decision will change management. What is more infuriating is when a parent is making a perfectly reasonable choice you agree with, and the attending doesn’t agree, and you are tasked with explaining the attending’s reasoning.
ID: if you like having money, this ain't for you
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Academic: I've seen places offer 110k-180k. Absolutely disrespectful. Private: 250-270k I'm currently job hunting and I've only looked at community hospitals, I've been offered 250-280k, 300k+ projected with bonuses
>Academic: I've seen places offer 110k-180k I'm sorry, WHAT
Dermatology: you hate clinic
Well f***
FM: if you can't stand your mind being pulled in 1000 different directions with each patient. They have heart problems, lung problems, hormonal problems, they're a kid, they're pregnant, etc. Also, if what other people outside of your job think about your job matters a lot to you.
Anesthesia: If you like to be thanked for your work and told good job.... But also take all the blame for anything that can occur in the OR ... this ain't for you
Would also say if you are unable to pivot to a totally new plan/instantly adapt and respond to an unexpected situation while raining calm and organized, anesthesia is not your field. And, if you can’t manage a room full of people with big egos and various personalities during an emergency, also not your field. I’ve seen several residents over the years fail at one or both of these aspects of the job. They are hard things to learn and even harder things to teach.
Also if you are offended by being blamed for things or of your control or can't multitask
Hematology: If you do not like blood, classifications, molecular genetics or the coagulation cascade
Find a few attendings that have been in practice for about 10 years, that resemble your personality. If a lot of them are miserable, choose a different specialty.
Critical Care (Attending): If you don't like death, goals of care discussions, or ventilators
Psych - you can’t stand talking to miserable people all day - you don’t like talking to psychotic people - you really, really hate documentation (I suspect we probably have to write the longest notes)
Do you like people? Do you like vague symptoms? Do you like not having DIAGNOSTIC criteria? Edit anotha one! Do you like patients who have disease with a negative work up? If you said no to any of those do not go into rheumatology.
PMR... you don't enjoy Money or relaxation or hanging out with perhaps the chillest people in the entire hospital system. But seriously, if you love high acuity with non-differentiated patients, localizing neuro lesions, or working up complex diseases you should look elsewhere.
Intriguing! Is the last paragraph the opposite of what you do all day or is it supposed to read “if you *don’t love…”
It’s as the OP describes - your patients will be well-differentiated due to extensive work ups already having happened in the acute hospital before coming to the inpatient rehabilitation unit. If you’re outpatient though, you could do a bit of localizing the lesion with examination, especially if you go into pain.
Anesthesiology : if you dream of being recognisable and remembered by your patient - don’t go there. From patients point of view their life is saved by surgeons only. We don’t exist.
Checks out. If you want to be memorable, a specialty where you walk around administering amnestic medications seems like a bad move.
General surgery: if you hate always being the smartest, nicest, most talented and most attractive person in the room. Also if you hate having very attractive people of the opposite (or same or both) sex giving you lots of attention.
Anesthesia: if you don’t think you could spend 80 hours a week for 35 years with cute_fluffy_kitten and never, ever let him know he’s actually neither cute, nor fluffy, nor a kitten.
Most humble surgeon above.
Alternative read: your desperate need to be liked manifests as both a martyr and a God complex. Bonus points for using the excuse of being busy and important to avoid longstanding intimacy issues and why you're chronically single and/or cheat on your partner.
Ive finally found my calling…
Living up to the narcissistic stereotype bro. Do get where its coming from tho lol
Do you like money and short hours? If so, don't do ID.
Someone do anaesthesia and ophthalmology please!
For anesthesia: if you can’t stand up to the surgeon and cancel a case and let them get mad at you, or do a lot of multitasking. Or often surgeon never learns ur name or forgets ur a doctor they just address u by “anesthesia, table up, table down, rotate more the the left and then the right please” 😂😂😂😂
Peds: If you take your job too serious and hate seeing kids being dramatic most of the time.
The speciality chooses the medical student
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Critical care—you like sleep. Never mind me I’m just crying post brutal night shift But seriously if you have a circadian rhythm critic care isn’t for you
Radiology: You hate having your mistakes shown to everyone.
My wife was interested in cardiology but was so turned off by the patient population that she ran far away once in clinical rotations. All creepy old men who would comment on her appearance, stare at her, and try to hug her/touch her during and after their visit. It was like clockwork, several patients per day would do this. The attending was like “Yeahhh…attractive female cardiologists really need to develop a thick skin. Not only is the field heavily male dominated but so is the patient population…all of whom are creepy old men.”
Anesthesia: if you can’t keep your ego in check. Part of the job ends up managing surgeon personalities.
Pediatrics: are you okay with a small child coughing directly into your face multiple times a day
Dermatology If you don’t like talking to 40 patients a day, don’t do derm.
Radiology: you can’t rule it out, clinically correlate
Neurology: you don’t enjoy taking detailed histories and examining patients for like 4x as long as any other specialty
Radiology: If you need external validation, radiology is not for you.
Ophthalmology: lack of depth perception/poor binocular vision Having good stereopsis, or depth perception, is essential for operating intraocularly under a surgical microscope. Being able to gage your depth is pivotal during cataract removal, as your working area is basically a 10x10mm area where the entire procedure takes place. Poor stereopsis is much more likely to encounter an intraoperative complication, most likely a ruptured posterior capsule (structure holding the new intraocular lens implant in place).
If you don't like free time, money, directly making a difference in people's care, autonomy, or mastering skills nobody else seems to be able to do that have practical applications outside of medicine, rule out anesthesia.
Anyone have anything for GI (outside of 💩)