Placeholder Image

Subtitles section Play video

  • In the last video, we covered the best lifestyle specialties as a doctor. Those were the specialties

  • in medicine you would choose if you wanted to work few, or at least predictable, hours

  • while still making good money. This is the oppositethe worst lifestyle specialties

  • for the masochists. Dr. Jubbal, MedSchoolInsiders.com.

  • To answer which specialties have the worst lifestyle, we first have to ask what makes

  • for a good lifestyle? The general consensus is that it comes down to three primary factors:

  • (1) the hours you work, meaning the predictability and total number per week, (2) the amount

  • of money you make relative to the amount of work put in, and (3) the quality or substance

  • of your work. This may include the patient population, types of cases you most commonly

  • deal with, or the amount of charting required. Don't overlook these factors, as dealing with

  • challenging patients or difficult and depressing outcomes day after day can drain you.

  • So why would someone choose a specialty with a difficult lifestyle? The biggest factor

  • is simply falling in love with the field. If you love excitement, unpredictability,

  • saving lives, and the operating room, you would love trauma surgery, and the challenging

  • lifestyle would be very worthwhile. Another theory I've heard thrown around is that those

  • who choose more challenging lifestyle specialties are workaholics at heart, and may prefer a

  • challenging and demanding work-life balance. They'll even brag about how bad their schedule

  • is. Workaholism is a common coping mechanism, as it's easier to ignore one's inner demons

  • when you're working and don't have time to think about them.

  • The relative appeal of a specialty's lifestyle is also highly subjective. Most would say

  • dermatologists have a better lifestyle than trauma surgeons, but some would disagree.

  • Neurosurgeons have some of the most challenging hours in the hospital, but they also have

  • the highest compensation, which is why we joke that they make the most money but have

  • no time to spend any of it. With that being said, know that this isn't a list of absolute

  • truths, but rather a subjective list of stereotypes for which there are many exceptions. Let's

  • have fun with this list and not take things too seriously. And remember, there are always

  • exceptions to any generalization. If you want a challenging lifestyle, you should

  • check out general surgery. The running joke amongst medical students is that you go into

  • general surgery if you're either a masochist or couldn't get into any more desirable surgical

  • specialty. This is obviously not the case and general surgery is a fantastic field with

  • lots to love, but the reason medical students joke about this is four-fold.

  • First, general surgeons work very challenging, unpredictable, and often long hours. Second,

  • they're often dealing with pathologies and body parts that some would consider less appealing

  • compared to other surgical specialties, like the intestines and its associated smells and

  • fluids. Third, they make less money than other surgical specialists. And fourth, it's the

  • least competitive surgical specialty to match into for residency.

  • That last point is why I always find it interesting when Caribbean medical schools brag about

  • how many of their students matched into general surgery. You can watch my thoughts on Caribbean

  • medical schools on my Caribbean playlist. General surgery used to be more, well, general,

  • dealing with a wide variety of pathologies. In rural settings, this is still certainly

  • the case, as there are few surgical specialists nearby. But as the field of medicine moves

  • further towards greater specialization, general surgeons primarily deal with gastrointestinal

  • and endocrine pathologies. If you want to work on the heart, you'll need to specialize

  • as a cardiothoracic surgeon. To work on bones, orthopedic surgery. For complex soft tissue

  • reconstruction or aesthetics, plastic surgery, and so on.

  • But general surgery remains the default path for the medical student pursuing surgery,

  • but who isn't quite sure what kind of surgery to pursue. After general surgery, you have

  • a wide variety of options for fellowship. For example, after general surgery residency

  • you could pursue specialized cardiothoracic or plastic surgery training, but note that

  • this will require a few more years of training versus matching into a dedicated CT or plastics

  • residency immediately after medical school. With the general surgery tract, the main drawback

  • is the increased length of training. The main benefits are that you have more time to make

  • a decision prior to committing to a subspecialization, and it's also a far less competitive path.

  • In fact, many CT or plastic surgery applicants when applying to residency will apply to general

  • surgery residency as a backup, just in case they don't match.

  • If you're enjoying the video so far, let me know by hitting the thumbs up. And if you

  • think I've gone off my rocker, hit that thumbs down button.

  • Next up is primary care. That's right, primary care has one of the worst lifestyles, and

  • you're probably scratching your head in disbelief. Allow me to explain.

  • You can become a primary care physician through various avenues, such as family medicine or

  • internal medicine amongst others. Most wouldn't consider primary care doctors to have a challenging

  • lifestyle since you'll generally be working regular office hours, roughly 40 hours per

  • week. But that's only one component of a specialty's lifestyle. There are three other components

  • that translate to primary care having a poor lifestyle.

  • First, as a primary care physician, you'll have lower compensation than most any other

  • specialist, averaging roughly $240,000 per year. That's not bad, but the average specialist

  • makes on average $350,000 per year in comparison. If $240,000 sounds like more than you'd ever

  • need, come back to me in 10 years when you have student loans to pay off, a mortgage,

  • family, car payments, and retirement to save for.

  • Second, the amount of charting and paperwork in primary care is abnormally high, in some

  • surveys averaging over 18 hours per week. In comparison, ophthalmology and anesthesiology

  • are close to half that. And third, scope creep issues primarily effect

  • primary care physicians, although anesthesiologists have also been subject to difficulties.

  • My mentor in medical school, who was an internal medicine primary care physician, advised me

  • and his other students that while medicine is a fantastic profession, he finds the changes

  • in primary care quite disconcerting. He pointed to these three issues of reductions in reimbursement,

  • increases in charting, and midlevel scope creep as primary concerns.

  • OB/GYN is an often misunderstood field, and most in medicine would warn you about its

  • terrible lifestyle implications. Some obstetricians and gynecologists have extremely challenging

  • lifestyles, and it doesn't help that their residencies have a reputation of being more

  • malignant than average. It's often a dreaded rotation by many third year medical students.

  • But as an attending, your lifestyle will be highly variable depending on your practice

  • type. It used to be the case that obstetrics was extremely challenging since babies don't

  • care about your sleep schedule, and you would have to rush to labor and delivery on a moment's

  • notice. But in recent years, OB has moved more towards the shift work model – a welcome

  • change in most people's eyes. Gynecologists, on the other hand, could have

  • a great lifestyle if they wanted to focus on primarily a clinic-based practice. Certain

  • gynecologic fellowships also offer a more procedural or surgical focus with relatively

  • few emergencies. You can learn more about the field in our So You Want to Be an OB/GYN

  • video. It's no surprise that surgical specialties

  • have challenging lifestyles, but not all surgical specialties are created equal.

  • Trauma surgery gets a bad rap since traumas are unpredictable and can come in at any moment,

  • seemingly at the most inopportune hours of the night. Many trauma surgeons have shift

  • work schedules, particularly at larger and more established institutions. It's not like

  • you're relaxing on your day off and you suddenly get called in. You're either on or off service,

  • but still the hours can be long and challenging. But others at smaller groups may have to manage

  • their own patients in house and aren't able to rely on more predictable shift work schedules.

  • Vascular surgery also comes with a particularly challenging lifestyle. You're specialized

  • enough that you're covering a large catchment area, meaning there will be emergencies happening

  • just about every night that require intervention. And unlike other specialties where you act

  • as a consulting service and hand the patient off for management to the primary team, as

  • a vascular surgeon you will be rounding and managing your own patients.

  • Neurosurgery is similar to vascular surgery in that regard, with the added complexity

  • and burden of dealing with very sick patients with often poor outcomes. When you think about

  • the types of patients that require brain surgery, you realize how many outcomes aren't as rosy

  • compared to some other surgical subspecialties. That was a surprisingly large factor that

  • actually pushed me away from the field. Neurosurgeons are widely known for working the craziest

  • hours in the hospital, but they're also the highest paid specialists. If you want

  • to know more about neurosurgery, we made a So You Want to Be episode on it.

  • There are certainly exceptions to all these trends. The ceiling for any given specialty

  • is limitless, meaning you could always work more hours. Many of my friends and colleagues

  • from medical school are now attending physicians, even in supposedly great lifestyle specialties,

  • but because they're young, hungry, and want to set up a strong foundation for their future

  • professional and financial lives, they're willing to grind extra hard for a year or

  • two before dialing their hours back. Your practice type will also influence your

  • lifestyle. In the early years, those who enter private practice will be working much harder

  • than those who are employed by a larger community or academic group. After all, they need to

  • slowly generate a patient census, be hard working to get referrals from other physicians,

  • and worry about all the aspects that go into running a successful business.

  • While private practice may be more common in something like plastic surgery, being employed

  • is the norm, and straight out of residency you will be working more reasonable hours

  • this way. Shift work is another arrangement that is more common in something like emergency

  • medicine. With shift work, it's easier to dial your hours down or up, depending on your

  • desired work-life balance. With surgery, shift work is less common, and you'll often have

  • to stay late if there are intraoperative complications. It's very rare for surgeons to work fewer

  • than 60 hours until later on in their career. Although within surgery, there are some that

  • are more conducive to clinic, allowing for reduced weekly commitments, like urology.

  • If you want to learn more, we covered this in So You Want to Be a Urologist.

  • Lifestyle should not be your primary consideration when choosing a specialty, but it is important.

  • In fact, I would say most in their early to mid twenties underestimate its importance.

  • Let me know with a comment below which specialty I missed. Or perhaps you're outraged and so

  • offended that I listed your specialty in this video. Regardless, I'd love to hear from you

  • with a comment down below. If you enjoyed this video, check out the best lifestyle specialties,

  • or the highest paid doctor specialties. Much love, and I'll see you guys there.

In the last video, we covered the best lifestyle specialties as a doctor. Those were the specialties

Subtitles and vocabulary

Operation of videos Adjust the video here to display the subtitles

B1 surgery lifestyle primary challenging surgical specialty

WORST Doctor Lifestyle Specialties

  • 6 0
    Summer posted on 2021/07/17
Video vocabulary