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Climbing Physicians!! Career advice requested.

Original Post
krispyyo · · Duluth, MN · Joined Apr 2006 · Points: 65

I'm in my third year of medical school right now. Trying to figure out which specialty to choose. Very good grades and board scores so far, so I don't think any specialty is completely out of reach for me at this point. For you docs that climb, what do you recommend for a sweet job that allows time for family, climbing, etc? I'm especially leaning toward orthopedic surgery right now, because it sounds like an amazing field. If anyone is an ortho doc, let me know if it really is possible to create a nice lifestyle in a good location after residency, even within the first few years out. Any and all advice is appreciated. Thanks!

Lee Green · · Edmonton, Alberta · Joined Nov 2011 · Points: 51

The "lifestyle" specialties (aka the ROAD - radiology, ortho, anesthesia, derm) can be very tough to find openings in the desirable locations. They're oversupplied to begin with, and all of them seem to want to live and practice in the kind of places you want to go. ER is often better (plus offers shifts that can let you go play), family docs are in demand just about everywhere, very portable if you want to change locations, and physiatry (PM&R) is often in high demand as well. Both fam med and PM&R will position you to do a sports medicine fellowship too, which may be useful for what you're contemplating.

wing thing · · Unknown Hometown · Joined Jun 2013 · Points: 115

Try Emergency Medicine. It's shift work and you can work as much you want.

Jim Fox · · Westminster, CO · Joined Jun 2014 · Points: 50

I did my residency in Internal Medicine but found the complexity, long hours and relatively low pay of IM not what I wanted.

I have practiced Occupational Medicine for the past 14 years & I work 8-5, M-F. no call. no holidays. No weekends. Pays pretty good & I have enjoyed spending time with my family. I have spent lots of time climbing with my son, backpacking, fly fishing, skiing, working out and enjoying life. Occ med is a little boring but it's a great lifestyle.

Ray Pinpillage · · West Egg · Joined Jul 2010 · Points: 180

Installing bolt-ons seems like a pretty good gig.

marty funkhouser · · Unknown Hometown · Joined Dec 2007 · Points: 20

Lower extremity plastic surgeon. You can fight the good fight against toe-besity.

krispyyo · · Duluth, MN · Joined Apr 2006 · Points: 65

Thanks for the replies everyone! These are some great things to think about.

Jim, thanks for sharing your experience with IM. That is among my top 5 choices, but it's good to hear that it may not be what it's cracked up to be. I just finished two months of IM, and it did drop down on my list throughout the rotations. Hospitalist work seems like sort of thankless job with high burnout and some of the subspecialties seem like they'd get boring. Occ med sounds like a nice option for lifestyle, how's the job market in desirable locations like Colorado?

Emergency medicine is definitely on my list, but I may want more continuity of patient care. However, the shiftwork lifestyle and the variety sounds nice.

Lee, good input on some of the ROAD specialties. I didn't realize that the market was so saturated in good places to live. Ortho surgery and anesthesia are probably two of the highest on my list. Is the market for these pretty saturated in Colorado and other nice places for a climber to live? I was under the impression that you could go just about anywhere as an ortho doc or anesthesiologist. Fam med sounds alright, but the long hours with the lowest pay seems like kind of a drag. Is it possible to create a nice lifestyle as a family doc? PM&R is also very high on my list, but I actually thought that was pretty saturated in places like Colorado. It sounds like this may not be true though which is good to hear. Please elaborate on the PM&R scene in desirable locations.

Thanks again everyone and I welcome more career advice so I can make a choice and stop agonizing over this decision!

Jim Fox · · Westminster, CO · Joined Jun 2014 · Points: 50

I did some hospitalist work & it was very interesting work but LONG hours and lots of stress. Hard to stay in that field long without burning out.

I work with a lot of physiatrists (PM&R) and they all have busy practices. Many do epidural injections, EMGs and various other procedures that reimburse well. Most seem to like what they are doing & I think there are job opportunites here in Denver.

ER is interesting but, again high burnout.
Might have to work odd shifts at first-nights, weekends, holidays.

Ortho is a great specialty but there are alot of them in CO.

There are usually lots of Occ Med jobs in Denver area. Not the most popular specialty & most of us in this field are trained in other specialties (Fam Med, IM, ER sometimes). To be honest, it's a frustrating job at times and not always the most interesting/challenging specialty. But you can't beat the lifestyle.

jdejace · · New England · Joined Sep 2013 · Points: 5

Have you done a Derm rotation? For the time being, it's a Goldilocks specialty if ever there was one (at least in the US where we're extremely vain). The hours, even in residency tend to be manageable. Residency is a long haul, and any surgical residency (eg Ortho) and even some of the ROAD stuff like anesthesia will be a beating by comparison. There are some procedures in Derm, it's mostly outpatient, the patients aren't actually sick and most of them are quite invested in their medical care and compliant. You may think it's all acne, but give it a chance, medical derm is really interesting. For the record: I'm not a dermatologist, but my SO is and I'm jealous.

I don't think you'll have too much trouble with location. As a climber you're typically not gunning for the big metro areas that most people consider desirable (NYC, Boston, DC, SoCal etc..) Sure, Colorado is becoming more competitive but not on the same level - most doctors aren't outdoor types as you may have noticed in school. A climber's paradise like Utah isn't high on most young physicians' list.

Jim Fox · · Westminster, CO · Joined Jun 2014 · Points: 50

I forgot about Derm. Actually a very interesting specialty but very hard to get a residency slot. Opthomology is another good choice if you are at the top of your med school class...

amarius · · Nowhere, OK · Joined Feb 2012 · Points: 20

One note - keep in mind that some specialties rely on finger dexterity and supple skin more than others ;)

Kevin D · · Phoenix, AZ · Joined Aug 2007 · Points: 160

I'm in Emergency Medicine and I don't think you can beat it. I work 13 days per month and with EM you don't get bogged down with the business side of things that come with private practice. Plus no on-call and residency is only 3 years

Andy Laakmann · · Bend, OR · Joined Jan 2001 · Points: 1,990
KevinD wrote:I'm in Emergency Medicine and I don't think you can beat it. I work 13 days per month and with EM you don't get bogged down with the business side of things that come with private practice. Plus no on-call and residency is only 3 years
Among my doc friends... Emergency Medicine seemed awesome. And then they had a family and kids and it became a real challenge.

I am good friends with two ophthalmologist here in Bend, and they are the happiest docs I know.

My advice: look +10 years in the future with regards to what you want.
Ryanb. · · Chattanooga · Joined Mar 2014 · Points: 5

Go either internal or family, become a locum tenens. You could take multiple months off at a time if you so desire. You could do stints near all the best climbing in North America and even work internationally.

requires mobility/flexibility but would provide the lifestyle

Lee Green · · Edmonton, Alberta · Joined Nov 2011 · Points: 51
krispyyo wrote:...Lee, good input on some of the ROAD specialties. I didn't realize that the market was so saturated in good places to live. Ortho surgery and anesthesia are probably two of the highest on my list. Is the market for these pretty saturated in Colorado and other nice places for a climber to live?...
Pretty much, yes. If you are looking for small towns off the beaten path, it's not so bad, but options are pretty limited and portability is tough.

krispyyo wrote:...Fam med sounds alright, but the long hours with the lowest pay seems like kind of a drag. Is it possible to create a nice lifestyle as a family doc?...
Better than it used to be, as primary care is in very high demand pretty much everywhere now. You have to be choosy though, get into a practice that uses the "medical home" model. Much nicer to live and practice in. The upside is that that high demand means you can be choosy. Pay is not great in the US, but I've moved to Canada where family docs get paid a lot better. (Terrific climbing up here, and being a whitewater kayaker and backcountry skier, it's heaven. Plus it's a great deal easier to deal with the single-payer system. Paperwork is a quarter of what it was in the US.)

krispyyo wrote:...PM&R is also very high on my list, but I actually thought that was pretty saturated in places like Colorado. It sounds like this may not be true though which is good to hear. Please elaborate on the PM&R scene in desirable locations...
PM&R generally is in demand, but for a specific site probably best to ask someone there locally. It usually means having a significant hospital system in the town, whereas fam med or ER is pretty universal.

The advice from Ryanb about doing locums is very much worth thinking about, IMO. About half the grads from my program do that, at least for a few years.
Chris Mak · · Unknown Hometown · Joined May 2009 · Points: 516
Lee Green wrote:The "lifestyle" specialties (aka the ROAD - radiology, ortho, anesthesia, derm)
Just have to add that Ortho is not a lifestyle specialty, the "O" in that ROAD acronym is for Ophthalmology. Ortho residents work 80+ hours a week, and from what I have seen once you are out in practice you can work even harder. Is it fun? Yes! And no doubt it is well reimbursed at the moment, and I have seen a small handful of guys play more than work, but if what you are focused on is pay per hour there are better options.
Jim Fox · · Westminster, CO · Joined Jun 2014 · Points: 50

I guess my best advice is to go into whatever specialty interests and excites you the most. You will be working hard for many years whatever specialty you choose, so pick something you will continue to find stimulating and rewarding.

I did my residency before they had hours limits and still did more climbing and skiing during those years than any other time in my life. You just learn to manage your time. I frequently worked an overnight call shift, then climbed afterwards before going home to sleep.

My only other advice is to make your family your first priority, no matter what else you do. My time with my wife and son has been the high point of my life.

Best of luck with your career.

Ryan Arnold · · SLC · Joined Jun 2012 · Points: 751

You'll be working more than you climb, so my advice is to choose the right career based on professional interest rather than lifestyle considerations.

For most of us, the job is quite a bit less ideal than you initially hope. I'm a double-fellowship trained radiologist, peds and IR. I'm living where I like and enjoy good hours and pay. However, being on pager every 3rd night and every 3rd weekend has been rough on my outdoor lifestyle.

If I'd dedicated the time and energy of medical training towards a business, like many of my smarter friends did, I'd be further ahead financially, would be my own boss, and would have had more time for myself and family during the past 15 years.

Dave Polan · · Worcester, Massachusetts · Joined Oct 2010 · Points: 40

You can't beat Emergency Medicine if you are truly after lifestyle first. You can be a successful physician, have time for family, and have a rewarding job without burning out. I practice EM at a busy academic center in new England and work 10-12 8 hour shifts a month with some (very flexible) teaching responsibilities. We have large group and the schedule is very flexible as a result. I routinely am able to take a week or more a month to travel (climb ski bike etc). No practice to manage, no call or pager EVER, job security: patients will keep coming/doing stupid things, and the ED in a hospital is always profitable. I can't think of a better profession if lifestyle and flexibility (both hours and geographically) are a priority. You just need to be honest with yourself about an irregular schedule, working very hard every shift in a chaotic environment, having continuity of care only for those patients you DON'T want to see again, etc. however. I thought hard about a surgical specialty, and to be honest would like the work better and perhaps be a better surgeon (!) however the length of training and subsequent lifestyle ruled it out. I know of NO place where you can practice surgery and take a month off to go to Alaska or have a week - 10 days off every month. No chance. And, you best have some killer own-occupation, specialty-specific disability insurance if you are going to be a surgeon or anesthesiologist and continue to climb hard. There are plenty of ways to subspecialize within EM (tox, disaster, international, critical care, ultrasound, wilderness medicine) to develop a niche and have an additional area of interest to fend off burnout.

krispyyo · · Duluth, MN · Joined Apr 2006 · Points: 65

WOW this is really great everyone! I really appreciate you all providing some input, these are some great things to think about.

The locum thing does indeed sound like a really cool option, but that could be a little harder for me since I am actually already married with two small children. I would be all over that if I went to med school a bit younger and single! It could be hard to travel that much since they will be in school by that time. On the other hand, my wife's a teacher and likes to travel so maybe that could work!

Jim, I like your advice of keeping family the highest priority and I completely agree with you. So far I've actually been able to find a nice balance between family and school while keeping my grades high. I want to continue this as best I can so anything with a reasonable residency (PM&R, derm, etc) would be great.

I like the idea of ortho, but it sounds like it's hard to get around the fact that it's a brutal residency, and I'm not sure if I'm willing to sacrifice the time with the fam. If the lifestyle isn't that great even after residency (no Alaska vacation time etc), then maybe it isn't what I'm looking for.

I may have mispoken in my original post in that maybe not all specialties are open to me. Ophtho would be my top choice and derm sounds pretty great too, but I don't know if I could get into these residencies. I have excellent grades and board scores, one research paper on Colorado EMS STEMI protocols that may or may not get published. It sound like people getting into ophtho these days not only have stellar grades/boards but have 5+ first-author published research specific to ophtho, same story for derm, some even take an extra year to do more research. I just don't know if I can hang with that level of competition.

EM has been one of my top choices from the beginning. It does sound like a great field and some of you guys sell it really well. It sounds almost perfect, but what's up with the high burnout? I'm guessing it's some of the things you mentioned Dave and maybe the odd hours are hard when you have kids?

Good to hear more of you saying that PM&R is in high demand, it was my top choice but I was getting discouraged when I started to hear (from questionable sources) that the market was pretty saturated. It's definitely now moving back up toward the top of the list.

Fam med is starting to sound better too, and moving to Canada would be just fine with me! Is it hard to find jobs and get work visas and such as a US trained physician, including in nice climber towns up there?

That's good advice from all of you saying to go with what interests me. I'll keep that in mind as I move through my third year. I've only done a few rotations so far. It just sucks that I have to start setting up 4th year audition rotations by February or so, so it seems like I gotta have it figured out by then, even though I won't even see everything by then!

Ultimately, I want something that offers an interesting job that I like doing in a good location, good lifestyle where I can be there for my family and climb, take vacations, comfortable pay (especially since I'll have 300k+ loans to pay off), reasonably non-brutal residency. Maybe I'm in fantasy land with all of these goals, but it seems like there's some good options out there.

Again, I really appreciate all of your responses, this definitely helps me. I'm always open to getting more information too, so keep posting if you think of anything else! Thanks!

Will Cohen · · Denver, Co · Joined Dec 2012 · Points: 80

As a fresh college grad and med school applicant taking his mcats in the next few weeks this thread has been immensely helpful.

Emergency Med has been my top choice with the hope of specializing in wilderness med, but obviously I'm too young and underexposed to have any legitimate idea of what my future desires will be.

Just wanted to say thanks for all the perspective y'all!

Guideline #1: Don't be a jerk.

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