<p>Seems like it. Been stuck on IM then Gastro Stuffo. Whatever. ;)</p>
<p>You have to do IM to do Gastro though.</p>
<p>Isn’t that what I said??? I get confused. ;)</p>
<p>Sorry - I thought you were saying she replaced IM with Gastro. :p</p>
<p>Well, in case anyone was keeping tabs, my 2 months of surgery has now essentially ended (all I have left is the shelf!), and I do not want to be a surgeon. Sure, operating on patients is exhilarating, but I just don’t think I could go for most of my career with such little patient interaction. I prefer my patients awake and not exsanguinating, thanks!</p>
<p>Onto IM!</p>
<p>^Kristin, you are in synch with my D. in regard how she feels about Surgery. She has felt this way all the way back in HS.<br>
She has also talked to few Surgery residents who have young children. No parenting time whatsoever, basically Hi and Goodbye (if these even happen at all). Another reason for not being crazy about Surgery.</p>
<p>Surgery isn’t the only specialty with “hi and bye” lifestyle. They are all plagued with that lifestyle depending on the practice you join. I know a surgeon who takes his children to school every morning and doesn’t start operating until 0900. He spends a lot of time with his patients. I would advise that you contact some recruiters or private practitioners to talk about the specialties you wish to pursue. What you see in academically related practices are far from reality.</p>
<p>^D. is going to many various places, lots and lots of clinic in her “planned” specialty. She also tends to communicate easily with others. It looks like she will have a pretty good idea. But as you mentioned “lifestyle depending on the practice you join”, not everything can be predicted, there are lots of surprizes ahead…And she has talked about her specialty with some people in high positions also who have collected lots of valuable information thru their career. Most of it was NOT “academically related practices”, she actually made sure to visit very socially/economically diverse places. She was at many for several days…
Frugal, I believe that your advise is very valuable.
This has been my D’s approach for her whole life. She does not care about prestige /ranks /how other feel, she needs to spend time at the place to form her own opinion about it and asses how she fits into this specific environment. However, at the end, she will be happy to match to a single place, she knows that this time around she will not be presented with many choices…</p>
<p>Right right, and those are points I sometimes overlook. It definitely seems like family friends in private practice have nice lifestyles than the academic docs I saw. It’s hard to envision your career as an attending when right now all you do is get there earliest, leave latest, and do relatively boring work throughout the day.</p>
<p>I wouldn’t say I hated surgery. I’m just not convinced I HAVE to be a surgeon, and it seems like most people I know who are surgeons knew pretty early in their education that they HAD to be a surgeon. As far as I can tell, I like the luxury of thinking through problems. I like building relationships with patients. I like being able to tweak something, wait and see, readjust, wait and see, etc. I thought the OR was stressful even when things were going smoothly and the patient was doing well. Even though it was only 8wks in an OR, I never got accustomed to the bizarre lack of creature comforts–you’re in a hot OR, with lots of people, wearing a huge gown and relatively thick gloves, you can’t scratch, sneeze, cross your arms, sit down, eat, drink, go to the bathroom, move from your 2’ x 2’ stool, etc for so many hours at a time. I don’t like spending the majority of my day uncomfortable (and I recognize that maybe I’m just a wimp!). I preferred clinic to the OR in each specialty I saw.</p>
<p>It’s interesting to me to realize that a career in medicine is soooo much more than just working on the organ system or pathology that interests you! (I think I knew that going into med school, but now that I’m actually spending all my time in the hospital, it becomes a lot more real.)</p>
<p>^Again, my D. seems to think the same, except that she may NOT like surgery with greater passion, which has been known to her for many many years (just imaginning what it would be) and HOT OR is HOT, hers was very warm because kids are more sensitive to temp., she was in pediatric surgery.</p>
<p>Here is the advice I have given to my medical students in the past. Fortunately for those who have taken it, they’ve had a high level of satisfaction. At least those who have reached me years later on Facebook.</p>
<p>IMHO: medical students absolutely have to view medicine as a business first and foremost. Unless you are volunteering or doing mission work, even they have to pay for something, the ugly side of medicine is that it is a business. The hospitals, nurses, insurers, staff, your partners and patients all worry about money. Therefore students should answer the question, “which specialty (business) am I comfortably able to own and run to meet my life goals?” I see students instead answering, “what do I like or what do I have a passion for?” This sounds like a harmless question but it has terrible consequences. What you may like may end up being a horrible business. </p>
<p>I have 2 friends who are anesthesiologists making ungodly amounts of money. One works about 50 hours per week, has 16 or 18 weeks off, on call q7 days and is in an MD only practice. Another works 75+ hours per week has 6 weeks off, directs 4 rooms at a time, on call q3-4 and makes the same amount of money. Another friend is a single mother pediatrician with 2 kids, but she earns more than the average anesthesiologist. Her FB page is littered with the family trips, activities, and updates of her kids. Another colleague is a neurosurgeon who only works 40-45 hours per week. You would be surprised how often people refuse to believe these scenarios exist. Even as a physician, I have come to realize how vastly different situations can be regardless of specialty. I never learned this in medical school or residency.</p>
<p>If my daughter told me she wanted to have a family, be a parent, and spend a lot of time with her children, I would tell her that other than the length of her residency, any specialty can provide her that. Even cardiovascular surgery or neurosurgery. Just the residency length and time would be the issue. Once she is done, she has to find or create the environment for her. It so happens she wants to be a neurosurgeon, only time will tell. Again, medicine is a business!</p>
<p>^ In his book Better, Atul Gawande talked about a similar example with a general surgeon colleague. The colleague did about six operations a week (which I guess is the norm?) and was never on call, yet still managed to rake in a $1.5 million salary. Of course, the doc. didn’t accept insurance and charged prices to what the market could bear, but it still goes to show that you can forge your own path in medicine and lead the life you want.</p>
<p>I have to read that book. The average surgeon I work with perform about 6 surgeries per day, usually 3 days per week. So, 18 per week. But I also work with an orthopedic surgeon who performs 20-48 surgeries each day, 3 days per week. I know he exceeded 2000 surgeries per year after his 2nd year in practice. I would guess he is at least 3000 per year now. He works fast but it looks effortless without any rush or deficiencies. I just want students to think outside the box and look far and wide for practice scenarios.</p>
<p>20-48 orthopedic procedures a day? Does he only do arthroscopic debridement? I thought the only people who could get up that high were the docs at the texas surgi centers that do multiple rounds of simultaneous lasik surgeries each day.</p>
<p>He does predominantly hand and sport surgeries. He will have shoulder (scopes, totals), knee arthroscopies and elbow surgeries lined up. He uses 3 dedicated rooms and maybe a 4th room if available. It is something to see in terms of OR efficiency. He is also the guy the other surgeons go to for their surgeries.</p>
<p>Thanks for your insight, frugaldoc! I’m definitely starting to realize the business side of medicine and give it some serious weight in my future choices. It was definitely something I dismissed in the past but now recognize is quite important. While money isn’t something I’m inherently worried about, I definitely find myself paying attention to lifestyle and various practice strategies when I’m evaluating my thoughts on a specialty. </p>
<p>I’m all ears for tips/advice/strategies/things to look for. Thanks!</p>
<p>Kristin, I am extremely cautious when posting and I limit what I say to prevent an attack from naysayers. Feel free to send me a direct message at any time. Here are a few newbie real life scenarios:</p>
<p>Met a new Ob/Gyn last week straight out of residency. After she walked away, one of the partners said, “she has no idea what she is in for, the 80 work rule is over, she won’t stop working after 24 hours, and the phone won’t stop ringing.”</p>
<p>An anesthesia friend of mine found a newbie anesthesiologist sitting and crying in the break room. He asked what was wrong. She said, “my head has been spinning ever since this morning. This is worse than my first day of medical school.” </p>
<p>One person I know tripled their first year income by taking a job in the Midwest. </p>
<p>You are on the right path if you start looking at your future from a business and situational perspective. Let me be clear, I am not saying anyone should chase the money.</p>
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<p>A very good description of the status quo. I’m not going to be part of that and will spend my professional life tearing it down and replacing it with something more befitting the noble profession I have joined. Change is coming much faster than some think. Even the whole idea of doctors as businessmen is fading away very quickly. My dad’s PCP (one of the last holdouts operating a small private practice in our area) has sold her practice and now works for the LLC she sold it to. She couldn’t be happier. She hated the business end of the profession. She hated dealing with the private insurance companies (much more so than Medicare) Now this is all done by the LLC, with the power of not one but one hundred physicians behind them. This is the future of medicine. A future that does not necessarily include private insurance. A future where hospitals, nurses, staff, your partners and patients ** won’t** all worry about money</p>
<p>Don’t think being a salaried employee is nirvana either. I have been a salaried physician for 33 years, it is still about productivity, how many RVU’s you generate a day, bean counters who audit how may tests you order, people ( non-physicians) who second guess your clinical judgements. There are pros and cons about private practice and just as many about being a salaried employee. Remember this, employees can be fired, let go, have their contracts not renewed, then you may have to move your family and try to find another position. neither system is perfect.</p>
<p>Hubbellsdad, you are completely correct. Plumazul, you are describing exactly what I am warning people about. These LLCs are the status quo. The private physician I am describing is what you are aspiring to be but you have to take care of the business end to accomplish that goal.</p>
<p>These LLCs, initially owned by physicians, but eventually sold to private equities have taken over medicine. They seem like great opportunities because they take the business headaches away from the providers but they are there to make a profit. The typical profit margin off of the physician is 20-25%. Physicians typically see an initial increase in income because those groups are enough to negotiate higher reimbursement rates. Once the terms of the sale agreement has ended 3-5 years later, these physicians find themselves compromising to the whims of corporate profit models. As a consultant, I have so many physicians calling me about the problems they find themselves in years later. But private equities have poured billions into buying practices just last year alone and the money is too much to pass up. They aren’t doing it for altruistic purposes. Doctors have absolutely screwed the profession by not taking care of business and allowing the hard core business people to take over. I admire your principles but I seriously hope you will do your best to learn more. Private equities want physicians who want to give up the business side. They just LOVE those physicians.</p>