For those of you who might be Physicians...

Hey there buddy...
I'm in my 4th year at NYU Med...not an MD yet.
Best advice I can give you at this point (with regards to getting the residency position of your choice) is to get involved with research as soon as you can. Clinical or lab...get it published, or contibute and get co-authored of course. During your third year clinical rotations, you may stick with what interests you now...or you may likely change your mind as something may strike you as your calling. I started thinking orthopedic surgery...then urology...then was juggling between neurosurgery and plastics.

With regards to a lot of people on this site being physicians...lol, i doubt that. It would be cool to start a thread and see who is out there. Most here are in business.

 

Two words.

Plastic Surgery

No one is sick

No one dies

Everyone pays!!!!!!

 

Great thing about plastics is that you really have the opportunity to go both ways. With reconstructive- operate on kids with craniofacial abnormalities, reconstruct after trauma and cancer removal....and then the complete opposite- cosmetics-to pay for your ferrari rims lol.

 

Graduated med school in 1987--so my thoughts may be a little out of date, but...

First of all, to be incredibly practical, how are your grades? One of the biggest issues is to be realistic about your chances to nail a residency. Interventional cardiology = internal medicine, which is an easy residency to get. Radiology, from what I hear, is relatively competitive. If you want to do a specific fellowship or additional training program (for example, cardiology), you are going to have to shine during your residency. If you haven't excelled during med school, this may be a good plan. If you did (are) excelling in med school, it might be wise to seize the opportunity now.

Regarding plastics, that equals 3 to 5 years of a general surgery residency. Yuck (in my humble opinion). A better option might be to set your eyes on facial plastic surgery. Requires an ENT residency (which wouldn't be a bad field to begin with), and allows the further facial plastic option (again, assuming you are stellar during your residency).

Of course, dermatology allows a fair amount of cosmetic options, and a very nice lifestyle (shameless personal plug). There is even a surgical fellowship after derm (dermatologic surgery/Mohs) which is what I do. Primary focus is on skin cancer resection, with secondary emphasis on reconstruction.

Then there are the typical considerations. Do you want a lifestyle field? Do you want to interact with patients or not (not = radiology, pathology, etc.--though there are obvious exceptions, e.g. interventional radiology).

The bottom line is get good grades (making AOA can be a huge issue), and when you get a slightly better idea of what you want to do try to do research or get a paper published in that field.

Good luck.

 

Mr. McGuire: I just want to say one word to you - just one word.
Ben: Yes sir.
Mr. McGuire: Are you listening?
Ben: Yes I am.
Mr. McGuire: 'Plastics.'
Ben: Exactly how do you mean?
Mr. McGuire: There's a great future in plastics. Think about it. Will you think about it?
Ben: Yes I will.
Mr. McGuire: Shh! Enough said. That's a deal.

 

Plastics or Interventional/(wallet-)Invasive Cardiology.

 

Congrats, I graduated from Northwestern in the 1990's . Great school.

Here is the reality of it:

Primary care: DON'T DO IT. DON'T EVEN THINK ABOUT IT. We all hate our jobs.

General Surgery: Same as above, but slightly more money

In hindsight: Derm, Radiology, Allergy. End of story. If nothing else, do it for lifestyle. If you have common sense, do it for money.

Folks pick various careers for noble causes. That wears of in about 2 years, then its a job.

Forget plastics. You have to do a general surgical residency. Few actually go beyond that. You will likely burn out and end up as a general surgeon.

Another hint: How much money you make, depends on LOCATION. Skills, contacts, place of residency MEAN NOTHING.

As a general internist, you can earn as little as 120,000$ per year, to 300,000$ per year. Average is 150,000$ or so. If you are willing to live outside of a big city, you can make the higher end of that.

Funny, how that works. Nationwide, the MEDIAN plastic surgeon makes 350,000$ or so. If you are a high producing internist, you can make ALMOST the same. Something to think about.

If you watch TV too much, you begin to think that plastic surgeons make 1 mm plus routinely. Ain't so...

 

Just to pile on to the last post--cosmetic surgery (and this DOES NOT EQUAL just plastic surgery) has the one advantage of not having to deal with insurance companies. Optho, Plastics, Facial Plastics (ENT), Derm are just a few of the specialties that open the cosmetic surgery door if you desire.

The big consideration (I think) is not $/year but $/hour. Do you want a job, or a job and a life. Lifestyle fields are not only good b/c they pay relatively well (but certainly not at the top), but one doesn't end of working that many hours (relatively). So the amount of money per hour worked is actually very, very good.

bpu699's post is loaded with truisms. I would only add that while medicine is a job, it is one that you are unlikely to switch. So make sure what you pick sounds engaging enough for 20-30 years. Switching isn't so easy.

 

Well, not totally true. It can be a workaday drudge for some larger firms I understand. I enjoyed primary care immensely when I did it but that was some years ago. FP guys can be such whiners...

I did family practice but was a flight surgeon doing Aerospace Medicine in the AF. Pay is just ok, not too difficult and can be quite the international adventure. On the civilian side there is a lot of research, NASA, FAA, Airlines, etc. If you like to fly, this can be a GREAT life - mine has been .

I also picked up a sideline in IM/IT (electronic medical record development) and automated community disease/injury medical surveillance. Medical IM/IT can pay extrodnarily well if done right. If you can, an MPH opens a lot of doors.

I now run an Aerospace medicine consulting firm with IM/IT and some international stuff (medical system development, clinical flight med) as well.

Bottom line - do what is fun, and look at the personalities and culture of the specialty you go into. You'll be hanging out with these folks for a long time....

Good luck and have fun in what ever you do.

www.operationalmedicalsolutions.com

 

Location is very important. Some locations are infested with lawyers and newspaper poles show "suing someone" to be second behind "winning the lottery" as a means of getting out of working for a living. This can make it impossible to practice a surgical specialty (even plastics).

In my field there are NO specialists in private practice. All driven out of town by lawyers and greedy insurance companies. I was forced to close down my practice (the last one in town) when insurance premiums put me in debt. I was forced to join a large medical center where I work twice as many hours for half the pay (compared to what I was making before the malpractice crisis). New Ferrari...Ha Ha, not as a private surgeon in this city.

13 years of training after graduate school (2 board certifications) = salary same as a nurse anesthetist.

Surgeons fee for 3 vessel bypass = $1900, includes all pre and postop care for first 60 days

Word is out: 45 US applicants for over 130 US cardiothoracic training positions this last year.

If you surgeon does not speak english, now you know why.

 

Maybe Orthopedics, I'm not a doc, but involed in healthcare IT for the last 8 years. From what I understand you have to be in the top of your class concerning grades...they are in BIG demand here in CA, we have been recruiting forever with no luck.

I know for a fact starting annual contract is above $200k for a new Ortho Surgeon out of residency/fellowship where I'm at.

 

Quit and go to dental school! Just kidding... Well... sorta!

The good gigs in medicine, to me, would seem to be (in no particular order): dermatology, radiology, plastic surgery.

Mike - damned glad he's a dentist!

 

200k start for an ortho surgeon is a joke, thats why you can't recruit. The average ortho guy makes 350,000$. In Wisconsin, its 1MM+. Any orthopod willing to work for 200k is doing something very very wrong.

 

Agreed.

In my area an average orthopod earns $600,000. One of my good friends clears 1.5MM(but he's a friggen meat-eater). I did orthopaedic spine hardware sales for close to a decade and orthopods CAN earn lots of money. Having said that, I know one former client who left to start his own medical distributorship, he now pockets twice what he did as a surgeon and works half the hours. Most of the orthopods I know now are planning/plotting a way out...

 

Its not just the orthpods leaving...I hear urologists are pulling out too (Uro, are you out there?!)...HMMM..he must be at work .

It will be fascinating to see what happens to healthcare...

As a med student, you have many choices ahead of you
"frogskin." Choose wisely...

If I remember correctly, the med schools push fairly hard for students to go into primary care. I knew no physicians on a personal level when I was in medschool, and I wish I had. Their advice would have been golden - and the same that I am offering you:

1) Don't go into medicine. Waste of time. You will never recoup the time-value of the money lost on your education. It is though, a guaranteed way to achieve a high-middle-class income.
2) If you are already in school, you are screwed. Your biology degree and 2-4 years of medschool are not "transferrable skills." So, make the best of it, and specialize.
3) Consider going to law school instead of residency. Greater income opportunity.
4) Being a doc is just a job. In most scenarios you will be treated as the hired help, on par with the receptionist. Patients as a whole are ungrateful, and see you as part of the problem. Your pay will be cut every year. Job satisfaction is zilch - you better have a good family life.
5) Play the lottery .

 

Indeed. You get what you pay for...healthcare is no different.

 

I find this fascinating, especially as a law student. There is greater income opportunity, but the average lawyer makes far less than the average doc. At the high end, there are lawyers who make high 7 and 8 figures but they are rare. As an outsider observation seems that the low 7's are kind of the limit for many docs unless they develop a new process, equipment, etc.

Also of note is your lack of job satisfaction. Do other docs feel that way nationally? Lawyers joke about how doctors are so beloved in comparison.

I do feel bad for docs in that they are getting hosed by HMO's and insurance companies more than anything, and the threat of socialized medicine. The whole malpractice deal blaming trial lawyers is BS... it's like blaming the rising cost of cars on the price of window gaskets (I've read >4% of premiums are paid out to malpractice claims). If the US socializes like Canada, salaries will be cut BIGTIME.

 

I know Florida State focuses on primary care. Others focus on research, though.

I've heard something like 90% of doctors dislike their jobs, lol. I've also heard that thing about the lottery.

 

6) Be a dentist! Great job satisfaction. Truly autonomous solo practice. YOU are the boss. Insurance is virtually a non-issue. "Banker's hours." Great income potential.

Mike

 

I have heard that dent salaries have been on the way down now too as large companies cut dental from their insurance offerings (if people have to pay for the maintenence visits out of their pocket it makes a difference as to how often the go to the dentist)

As far as banker's hours go, my dentist takes apointments until 8:00 p.m., he says for the convenience of his patients, but I truely think that he needs the extra income to cover his expenses as he always has the latest in everything (digital, low dose x-rays, intra-oral cameras etc.)

There does seem to be a push towards the cosmetic side of dentistry as everyone in the world is suddenly pushing veneers and 'Zoom' tooth whitening so maybe that is the way to go.

 

Dental salaries have been going up and up for years. They are DEFINITELY not going down. In fact, a few years ago, the average salary of a dentist surpassed that of physicians. Dentistry is by and large paid out of pocket and always has been. The less insurance is involved, the BETTER. Only 23% of my patients have some sort of dental benefit plan. 77% are cash patients. I work M-Th, 9am - 5pm. No hospital call. VERY few after hours emergencies. I can count on one hand the number of times I may go to the office after hours in a year.

Maintenance dental visits are so inexpensive that having "insurance" is foolish. More is spent on hair care than on dentistry nationwide. So-called "dental insurance" is so limited, it is of little consequence. We call it the "tooth of the year club." If you were to only use your dental benefit plan, you have enough to fix ONE tooth.

As for pushing cosmetic treatment. It's the PUBLIC that is pushing it. I've never once "sold" cosmetic treatment to a patient. And, a good portion of my practice is cosmetic. The patients come ASKING for it. Blame it on our culture, Hollywood, the media, etc. We're just providing what the public is demanding. I've never once been the one to bring up cosmetic treatment to a patient. They ALL come to me ASKING for it. I did anticipate this trend and got the training I needed to ride that wave.

"Dentistry has been berry berry good to me!" (borrowing from Chico Escuela - aka Garret Morris - on SNL)

Mike

 

Ive gotta agree with FastLiz. Ill have my PharmD in a few months, but If I could go back in time Id be applying to dental school.

I really dont see dental salaries going down anytime soon. With all those cash cosmetics/procedures you guys must be cleaning up pretty well. Even in the pharmacy world- any kind of specialty compounded med generates a much greater profit cus no insurance company will ever cover it. Cash is king in medicine.

 

First do what you like. You will be doing it a long time.
I was a dentist for 10 years, what a boring job. Changed to med school and radiology, never regretted a day. took 9 years from starting job change to working but made up the lossed income in 2-3 years. I work for a big group without nightcall or weekends, strictly 8-5, no holidays.
Work is great and challenging, great technology and science, never a dull day.
Make mid 6 figures, very adequate.