Lifestyle Specialties

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Originally posted by GeddyLee
Hmmm...I don't know why Dr. Cuts thinks Radiology is so well shielded against medicare cuts. 10 years ago, ophthalmologists were makine $2000 per eye to do cataracts...now they make around $600. Similar cuts in reimbursements have struck nearly every field of medicine. Radiology will get it's share in due time.

As for the supposed "shortage" of radiologists which is driving salaries up....maybe there wouldn't be a shortage of those guys wouldn't take 20 weeks of vacation per year. All the more reason to cut reimbursements....get these vacationing radiologists back to work. It would ease the "shortage" and reduce overall cost for the system.

Anyway....now that we're all done yanking off about lifestyle specialties, maybe you should all do something you might actually be interested in. I cringe everytime I hear of someone doing a certain specialty because of the lifestyle.

How many of you told your interviewers in medical school that you wanted to become a doctor so you could eventually become a radiologist, ophthalmologist or dermatologist so you could make lots of money and work only 40 hours per week? Don't you think it's a little unethical to lie your way into medical school?

I would bet everyone that does a specialty purely for the lifestyle probably gave the "i wanna be a general practicioner in a rural setting just so I can help people" line when the interviewed.

Speaking of interviews...what do you tell the selection committees when you interview for your lifestyle specialty? Do you speak the truth and say that you are interested in the specialty because of the great money and lifestyle? OR, do you lie?

For such a fine, upstanding lot of people as get accepted to medical school, I sure am apalled at all of the lying, backstabbing, and gluttony that exists.
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Dude you seriously have to get off your high horse.

First medicare cuts have already affected radiology just like every other medical specialty. MRIs use to reimburse at around $1,800 in the 80's now they are somewhere around $400-500.

I have never heard about a radiology group that has 20 weeks of vacation. There may be one that exists but I haven't heard of one. You certainly could get a job working with 20 weeks off, but you could do that in most fields of medicine if you really wanted to. I know primary care docs that work 3 days a week at a clinic and I know radiologists who take 2 weeks of vacation a year and that's it.

Let me ask you what did YOU tell your med school interviewer when you were applying to med school? Let me guess, it had nothing to do with ophthalmology did it? Somehow I am sure that it wasn't about how being an eye doctor was your life's calling. Yet here you are ripping everybody else for some they may or may not have done. I was truthful in my interviews. I had no idea what kind of doctor I was going to become and told them so.

Instead of worrying about what everybody else is doing and what their motivations could be, why don't you just worry about yourself and getting into opthalmology?
 
Originally posted by Goober

First medicare cuts have already affected radiology just like every other medical specialty. MRIs use to reimburse at around $1,800 in the 80's now they are somewhere around $400-500.
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Also, note that only 1/10th to 1/5th of a radiology exam fee is the professional fee for the radiologists. The rest is the technical fee for equipment, films, PACS, networking, auxillary personnel, rent, maintenance, and other overhead. So, if the hospital owns the equipment, most of the money goes into the pockets of all physicians and nonphysicians in the hospital, including the ER docs, surgeons, IM, nurses, CEO, janitors, security guards. If radiologists don't own equipment, they don't make the really high salaries. In my hospital, the majority of the salary of the ER physicians is paid by the radiology department revenues which goes into a fund belonging to the hospital. I have been told that our ER itself, is a money losing operation because of the population mix of our ER patients.
 
Originally posted by GeddyLee

Speaking of interviews...what do you tell the selection committees when you interview for your lifestyle specialty? Do you speak the truth and say that you are interested in the specialty because of the great money and lifestyle? OR, do you lie?
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I agree with GeddyLee that lifestyle should not be the primary factor driving interest in a particular specialty. However, I also believe being honest with the admissions people can help. When I interviewed, I clearly stated that my interests in ophthalmology were:

1) neuroscience and visual system
2) ability to experience instant gratification in the clinics and ophthalmic surgeries
3) lifestyle of the ophthalmologist

I emphasized that the lifestyle of the ophthalmologist allowed me to do surgeries and see patients without jeopardizing my time with my family and academic endeavors. Unlike other surgical fields, ophthalmology allows time to do research. Everyone in ophthalmology realize the benefits of not having many inpatients and mostly outpatient surgeries. 🙂
 
Originally posted by GeddyLee


How many of you told your interviewers in medical school that you wanted to become a doctor so you could eventually become a radiologist, ophthalmologist or dermatologist so you could make lots of money and work only 40 hours per week? Don't you think it's a little unethical to lie your way into medical school?

I would bet everyone that does a specialty purely for the lifestyle probably gave the "i wanna be a general practicioner in a rural setting just so I can help people" line when the interviewed.

Speaking of interviews...what do you tell the selection committees when you interview for your lifestyle specialty? Do you speak the truth and say that you are interested in the specialty because of the great money and lifestyle? OR, do you lie?

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Actually, I had a classmate undergrad who i) graduated from university when he was 18 with a 4.0 ii) had undergrad research and iii) scored a 43 on the MCAT. He applied to Ivy league east coast and Stanford west coast and his state school as a fall back. He got rejected from all of the ivy league schools and was interviewing for his state when the interview was summarily ended. Evidently, on his essay he stated his reasons for wanting to be a doctor, which included his scientific interest and desire to become a radiologist, for lifestyle reasons. When the interviewer asked him if he didn't think he should want to become a doctor to help people, he replied,"I didn't want fill my essay with cliches and platitudes." Interview over. .. He had to request a second interview or he may not have gotten in.

I told the guy I didn't respect his motives for wanting to go into medicine, but I really respected his honesty. Evidently, most of the admissions boards didn't though.
 
Originally posted by ophtho1122
I've heard complaints from surgeons at my school that sometimes the Radiologists make more on a surgical patient than the surgeon due to higher reimbursements for RADS. I believe this trend will definitely reverse in the near future. I also think the misuse/overuse of radiological studies will be curtailed in the future leading to lower Rads salaries. It's crazy when you see one study done only to have the Radiologist equivocate on the findings leading to an even more expensive study being ran, and yet another after that to confirm what was believed to be the diagnosis in the first place. That's the way to make money in Rads; start off with the most unreliable study you can order, equivocate, then work your way up to the most expensive study, racking up major bucks along the way, then look like the hero when you finally confirm the diagnosis.
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A very ill informed post. Although long, please read Docxter's post above as he stated everything that I intended to write.

If you knew how many findings radiologists made a decision on a lesion being benign despite the fact that the differentital includes malignant processes, you would realize that the goal of most radiologists is NOT to generate more work. Clinicians order many questionably indicated studies to cover their butts and all it does is shift some of their liablity to the radiologist. They don't seem to understand the limits of the technology. Every time you see a radiologist have to hedge in a report, think of the clinician who basically hedged because (and I get this MANY times a day) they don't think there is anything wrong but they ordered the exam "Just to be sure."
 
Originally posted by GeddyLee

As for the supposed "shortage" of radiologists which is driving salaries up....maybe there wouldn't be a shortage of those guys wouldn't take 20 weeks of vacation per year. All the more reason to cut reimbursements....get these vacationing radiologists back to work. It would ease the "shortage" and reduce overall cost for the system.

How many of you told your interviewers in medical school that you wanted to become a doctor so you could eventually become a radiologist, ophthalmologist or dermatologist so you could make lots of money and work only 40 hours per week? Don't you think it's a little unethical to lie your way into medical school?
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The majority of Radiologists work extremely hard. I'm not sure where this notion that Radiologists jsut sit on their ass and read 10 films a day. It's hard, taxing work. There's a lot to know, and most of the important findings are subtle... that's why you have radiologists. Anybody can pick out the left lower lobe consolidation on a CXR, but you need radiologists for the more difficult diagnoses. How many times have you seen a clinician come to the Radiologist asking for advice on management of a patient, simply based on imaging findings.

As far as choosing your speciality in medical school... people's priorities change and they get exposed to entirely new things in Med school. Who knows that they want to be a pediatric endocrinologist or a pain specialist before they start med school -- very few I assume.
 
Interesting post.
The diagnosis is made by the clinician after correlating signs and symptoms with investigations which include radiologic as well as lab tests. In this age of severe malpractice liability physicians want to keep themselves safe and well documented which is no doubt increasing the cost of healthcare.
Many people change priorities during or after med school after evaluating their likes /dislikes , temperament and career goals.
The stress of medical malpractice is so much that physicians with great clinical skills are forced to order excessive investigations , to document everything and be safe. It takes just one law suit to finish your life , to rid you of all peace. In such times radiology as a speciality plays a different role which few people recognize.
But the imaging alone can never diagnose or provide guidelines to manage , it always has to be correlated with signs and symptoms. How many times i have seen patients with SDH on CT left alone because drainage is not needed since consciousness and higher functions are normal. I have even seen a case of posterior fossa EDH with GCS 15/15 which was monitored in ICU but not drained . On close follow up it resolved. Many cases of SAH , but grade 5 0r 4 which were not operated because were not fit for surgery. I am not saying it happens in majority of cases , but it is also not uncommon.
Majority of times the clinician knows what to do and makes up his mind regarding management , but still orders extra inv just to safe his skin because he doesn't want a lawyer make him miserable later on. Frivulous law suits are the worst thing to happen to modern medicine.
 
Lots of "wave of the future" talk.

I thought kickboxing was the "wave of the future." Kickboxing.
 
The next issue is that a lot a of docs in many specialties have come to believe that radiological tests are definitive studies. NO, MANY OF THEM ARE NOT.
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I listened to talk by a surgical resident yesterday about how to diagnose a hepatoma. They were all radiological tests. Never once did he mention biopsy, which is ridiculous as no doc would treat or tell someone they had a hepatoma without histology.

Before this guy goes into practice hopefully he learns that you would never take anyone to the O.R. or start chemo based on a radiological "diagnosis" of malignancy.
 
Originally posted by Ligament
You could argue either way, but I for one do NOT see ER as a lifestyle specialty.
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It is often lumped in with "lifestyle specialties" because people have to consider the lifestyle before going in. For some, the flexibility associated with not having a practice is a huge draw. For others, the nights, weekends, and holidays at work are not the lifestyle they seek.

The fact remains, that most EPs work 10-15 8-12 hour shifts a month, which is far less time at work than most physicians, including dermatologists, opthalmologists and others. Radiology has similar potential, but someone still has to read films on nights, weekends, and holidays.
 
Originally posted by pathstudent
I listened to talk by a surgical resident yesterday about how to diagnose a hepatoma. They were all radiological tests. Never once did he mention biopsy, which is ridiculous as no doc would treat or tell someone they had a hepatoma without histology.

Before this guy goes into practice hopefully he learns that you would never take anyone to the O.R. or start chemo based on a radiological "diagnosis" of malignancy.
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Actually, hepatoma is one of the malignancies that can be diagnosed on imaging. If you have a hypervascular tumor in the presence of cirrhosis, it is going to be a hepatoma. Biopsy is relatively contraindicated due to the risk of bleeding in these hypervascular tumors in patients that often have coagulopathy due to their cirrhosis. Only in questionable cases or when there are multiple lesions are biopsies done. Many people undergo surgery and radiofrequency ablation of hepatocellular carcinoma without histology.
 
WhiskerBarrelCortex has given an excellent response to which I can only add that patients go to the OR all the time without a definitive diagnosis.

They undergo an exploratory laparotomy and patients are told the possible diagnoses pre-op and how they will be treated once a more definitive diagnosis is had.
 
maybe pathstudent needs to take the next step and become pathresident.😎
 
I chose EM a big part b/c of the lifestyle..obviously I LOVE EM..but I also LOVED surgery and OB/Gyn...

The thing with EM is Flexibility...As a female and future mom..I hope..I want to work part time...EP's can work as little as 10 shifts a month..think of all that extra time, no beeper, no call time to spend with your family...but YES, EM is stressful..I guess to some..to me I LOVE it..Im bored to death in the clinic..but honestly, it is a personality fit..you have to find your 'fit'.

That is all I can really offer.. EM fits me perfectly..lifestyle and all. yes, I wil have to work some nights and weekends, but the time I have off to take my kids to games, school functions, ect is much more valuable.

~Pegasus~
 
WhiskerBarrelCortex has given an excellent response to which I can only add that patients go to the OR all the time without a definitive diagnosis.
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THat is true, but the course of the operation is often determined by intra-operative consultation by a pathologist. I guess I also mean that no surgeon would ever treat osteosarc based on radiology and many other such tumors.

Thanks I didn't know that about HCC. I have seen a number of liver biopsies with HCC though so it is obviously not contraindicated.
 
It is interesting. I am doing a hemeonc rotation now. We have one patient with Hep B who presented with a huge (17cm) liver mass and a satellite lesion. They wanted biopsy before proceeding. Second patient with alcoholic cirrhosis, liver mass (5cm). They don't want a biopsy.

It's not all based on clinical and lab data either. The first patient had an AFP that was off the charts. The second had one that was only slightly elevated.

Anyway, don't want to drag down a thread on lifestyle specialties with more about HCC. Or osteosarcomas because sometimes these are treated before biopsy. The truth is though that most things get biopsies before definitive treatment.

About ER though - I think for some you could consider this a perfect lifestyle specialty, mostly because it doesn't have to be 9-5. Some people prefer a night shift, or regular evening shift, etc. 9-5 is tough if you have young kids. 3-12 can be better because you can be home most of the daywith them.

Seriously, though, lifestyle is all up to the individual. You can be a general surgeon and have great hours if you want, you just might not get paid much or have much career advancement. If you want to succeed in anything you will probably have to work hard.
 
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