Thursday, January 12, 2012

Competitive Specialties

Entering clinicals, I never expected to like the more "procedural" specialties. But ever since I scrubbed into my first C-Section in OBGYN, I've been drawn to the OR. The excitement, the atmosphere, the sense of accomplishment, the work of having a few, long, nice projects to work on for the day and the ability to see a difference in a patient after surgery are all very attractive to me. I can see that much of my pre-clinical work was also project oriented, even if it had little to do with surgery.

If only things were so simple. I decided to take SGU up on there clinical academic advising services (something I made good use of in basic sciences with the great Dr. DB). I sent in my CV, GPA, Step 1 and goals of matching in Surg or OBGYN. I will say Dr. PB (the clinical advisor) gave me some needed advice and gave a great critique of my resume. But he basically said I have less than a coin flip's chance of matching in either specialty. Not a 0 chance, but not great either. It's tough news, but I'm thinking about what I can do to change my chances and think hard about what I like about the OR.

But it got me angry and thinking about WHY certain specialties have cut offs. Does someone need to be that much smarter to go into General Surgery than to go into Family Medicine? Is the academic training of Dermatology really more broad than Primary Care?

From my experience in medicine: No. In fact, general practice is in many ways more challenging intellectually - you really have to know the subtle signs of sickness to catch the deadly diseases early among the sea of worried well. No, there is something else at play, as DJ Shadow once alluded to...

The most competitive specialties pay the best. Lifestyle is a part of this, which is why EM - a midrange compensation - is becoming highly sought after. This is not surprising if one is a cynic, but it's disheartening if one is kinda typical on stats paper but wants to follow their interests and make a difference in a field. We live in a capitalistic society, so I guess I shouldn't expect things to be different - it's just always startling when the brutal reality of it stares you in the face. I just wonder what the distribution of Derm vs. Family vs. Surgery vs. Psych would be if all of them paid the same and had the same hours. And what that would do to the delivery of healthcare in this country. Considering how many physicians I've hear complaining about compensation cuts, I'm guessing it would be a bit different than today :)

F/U post comparing specialty distrubution in other healthcare systems (europe, canada, india) to follow...

2 comments:

Spice Island Queen said...

Interesting observations. I think I share your sentiments. I am lucky in that I'm drawn to the more "non-competitive" fields and don't care so much how much money I make but it is disheartening to see so many smart people select based on lifestyle or money and not on what they really want to do...

JP said...

Glad to hear your following what you love to do. When we're done, we have to live 50-60hours a week with what we choose and no amount of money can compensate for daily misery.

I find it odd I heard more complaining about salary in surgery, who on average make 280-380k, than I did in peds who make 160-220k. AAMC specialty info

I've heard more than once the "plumber" story ("omg, don't you know, plumbers make more than surgeons, they make like 250 in nyc") to which I will no reply "really, you went into medicine so you could say you made more money than a plumber?"

I think it just reflects how skewed our priorities are as a society.