Sunday, September 28, 2014

Which Medical Specialty Should Medical Students Choose?

A medical student recently asked my advice on her decision to pursue a career in dermatology.  It was about 25 years ago when my own parents encouraged me to pursue this specialty.   What was their deal?  Perhaps, they anticipated future developments in the field and were hoping for free Botox treatments?   As readers know, I rejected the rarefied world of pustules and itchy skin rashes for the glamor of hemorrhoids, diarrhea and vomit. 

My parents were making a lifestyle recommendation.     Dermatologists are doctors who sleep through the night.  Spying one in a hospital is a rarer sighting than spotting a liberal Democrat at a Michelle Bachmann rally (unless a planted heckler).  Nocturnal acne medical emergencies are uncommon.   And anyone who has had cosmetic work done understands painfully that this is a cash business.

Diagram of Skin
Luckily, the Whistleblower is thick-skinned

Here’s where some readers or Dermophiles will accuse me of skin envy.  Not true.  Some dermatologists may be a tad thin-skinned over this assertion, but facts are facts.  These docs have a soft lifestyle and earn much more money than most physicians do.   Sure, these guys and gals see some serious stuff, but the nature of their specialty is less intense and frenetic than that of other colleagues.  

Many professions push back when it is suggested that they are afforded unique and soft perks that most of us don’t have.  Teachers, for example, never state out loud that having every Federal holiday off, enjoying school vacations every few months and having 10 weeks off in the summer are unbelievable soft padding that no one else has.  We know you work hard under difficult circumstances and we respect you and your profession.  But just admit that you have some unbelievable professional cushions.  This won’t diminish your self-worth or contributions to society. 

Many medical interns and residents don’t consider lifestyle when they are making their career choice, and they should.  Obstetrics is thrilling when you are 30 years old.  Fifteen years later when you are overworked, tired and have your own kids, it may be slightly less thrilling to bring new life into this peaceful world in the middle of the night on a regular basis. 

For me, leaving my own bed at an ungodly hour to haul out to the hospital is an unwelcome activity.  I do not relish being awakened with phone calls or having to attend to an individual in the emergency room when the rest of Cleveland is soundly snoring.   While gastroenterology is a more taxing specialty than the skin gig, it is still uncommon for me to have leave for the hospital during the black of night.   Since we are in the era of medical hospitalists who are on staff around the clock, there is only a rare need for me to make a personal appearance.   On most nights, my scope rests securely in its holster. 

Do I think that medical students should consider lifestyle as they are contemplating their future?   Absolutely.   Indeed, the emerging culture of the medical profession has morphed from the prior culture when doctors worked 24/7 and interns were proudly on-call every other night.   Medical doctors today are increasingly employed by institutions, work shifts and delegate the hassles of hospital life to hospitalists. Doctors are self-prescribing R & R.  

Leisure, relaxation, avocations and personal time for reflection are not evil pursuits.  They are the fuel that cultivates and sustains our humanity.   Who wouldn’t welcome a little more humanity in the medical profession?


Anonymous said...

I don't care if the dermatologist or the radiologist has cush hours, but I think it is a little outrageous when they make a lot more money than some other specialties, despite their cush lifestyle. Why don't doctors working nights and weekends get a 50% raise, at the expense of the lifestyle specialists? Who ever decided what various specialties make? (I am not as dumb as I sound -- I know that the AMA and cronies have that smoke-filled room.)
Obviously the system is rigged to screw the doctors caring for sick patients, and this fact indicates to me that our system just wants the sick patients to die.

Michael Kirsch, M.D. said...

Comment appreciated. Your observation of income inequity should not be restricted to the medical profession. Should a professional athlete or recording artist be paid 100 times more than a teacher?

Anonymous said...

A GI doc complaining about a Dermatologist's lifestyle? Give me a break. I have yet to see a GI doc admit their own patients, rather than see them just as consultants - no different than Derm.

Anonymous said...

From Anon 1: you ask if athletes, singers, entertainers should make 100 times more than a teacher does. No, I don't. I think that this phenomenon is a sign of cultural decadence -- we generally crave entertainment much more than learning. Hence, if the demand for teachers is low, so is their salary.
I personally don't support the 20 million/year atheletes; I will never pay $80 to attend a sporting event (or whatever is the going ticket price now.)
My comment for Anon 2: GI works a lot more on weekends and evenings than does derm, and they see sicker patients, typically. CBD stones and bleeding ulcers can't wait 3 months to get into the outpatient clinic. I have seen GI hundreds of times in the hospital; derm maybe 1-2 x.

Add this