Do you agree?

Here is a clip of an article I read recently....

CHICAGO (Reuters) - The stereotype of the rich doctor might be due for some surgery. An increasing number of medical students are picking their specialty based on the lifestyle it permits, including more time to spend with family, rather than such traditional factors as pay and prestige, according to a study published on Tuesday in the Journal of the American Medical Association.
"We're being told essentially that it's not the number of hours or the intensity of the work, it's the ability at the end of the day to close out the work day and go home and be away from professional responsibilities," Gregory Rutecki, one of the study's authors, said.
"The trend may also represent the increasing number of women in the profession," who seek a closer balance between family and professional duties, Rutecki said.
The finding points to potential shortages of doctors in specialties such as family practice, surgery, and obstetrics as medical students shun fields where they are required to be on-call during many off hours, the report said.
"We're going to have person-power shortages in the next 10 years in critical areas. Where are the primary care doctors going to come from?" said Rutecki, a physician and professor at Northwestern University.
The report said previous studies also have detected the trend, with students more inclined to select specialties with fewer work hours per week and fewer nights on-call.
Researchers collected six years of data from industry matching programs that direct graduating medical students to hospital residencies in their chosen specialties, with professions offering more defined hours gaining favor.
From 1996 to 2002, the percentage of students surveyed who chose anesthesiology grew to 6.4 percent from 1.1 percent, dermatology was picked by 2.3 percent up from 0.2 percent, and radiology was chosen by 6.1 percent in 2002 versus 3.3 percent in 1996. On the other hand, 9.5 percent chose family practice in 2002 compared to 16.1 percent in 1996, and 7.6 percent chose general surgery versus 10.4 percent six years earlier.
Through the length of the study, 55 percent of students' choices related to lifestyle factors, compared to 9 percent basing their decisions on potential income.
The increasing number of women doctors and general practitioners' loss of decision-making to insurance companies will likely exacerbate the trend, Rutecki said.

My DW has long said that she always wanted to be a pediatrician, since she was a little girl. I don't think at that time it was a lifestyle choice.

Since then, she has nearly gone into IM, Anesthesia, and Radiology. Overall, the last two were more "family" oriented programs where she was looking to go. She has since stuck with Peds, she would like to specialize farther but will have to weigh that out after the Air Force committment. That could mean more call nights and less family time, but it may make her much happier with her daily job. I would have to say that she is driven to be the best in her field, reguardless of what she is paid.

Although, it would be nice to get paid well since she has about 2 1/2 tons of student loans to pay back.

[houseelf]

I will have to come back to this message when I have more time but I know that this is a critical issue that General Surgery faces. More individuals with an interest in surgery are opting for the surgical subspecialties or similar career paths like ENT, radiology, etc because of the enormous commitment necessary to complete a surgical residency. This means that the pool of applicants is diminishing while the predicted demand for surgeons will soar with an ever increasing aging population. One of hubby's jounals devoted a whole issue to the impending crisis a few months ago. I'll try to pull it and review it so hat I can comment more intelligently here. Nonetheless, you have tapped into a huge issue for the field of surgery.

In our case, DH loves surgery. He comes alive when operating or talking about it. While sometimes I wish that I could have steered him to another specialty, he is a surgeon to the core.

More later,

Kelly

[migirl]

I picked "Total lifestyle choice" but wanted to clarify my answer a little ... DH chose to go into urology because it was a good lifestyle profession but also because he genuinely enjoys it and strives to excel. At the end of the day, if he's just finished a bunch of urologic procedures he is infinitely happier than if he's done a bunch of general surgery procedures which IMO is a huge factor. (Interestingly, when he started med school he always thought that he would go into family practice like his grandfather. But after being exposed to the different rotations and subspecialties, he realized the benefits (for him) of going into urology.)

I found this article very interesting because many of DH's med school classmates also went into surgical subspecialities or otherwise "family-friendly" fields. After going through a general surgery internship I can certainly understand the appeal.

[SuzySunshine]

I picked driven, otherwise why would you want to be a neurosurgeon? Seriously, he has been doing brain related research since he was an undergrad, he loves the detail of surgery and the results of seeing a patient with a tremor be "tremorless" afterwards. I saw this article this morning and actually send it to my husband I'll be interested to see what it says.

I agree totally with the article based on one small fact. At Stanford this year, out of a class of 85 there are 18 wanting to match derm, yep more than 20%! We were shocked.

Very interesting...

[mommax3]

I have posted before that when DH finished his first night on call as an MSIII doing an OB rotation, he came home exhausted but with a light in his eyes, and I knew at that moment what he would end up choosing. He struggled a lot with the choice and seriously considered Family Practice, but he LOVES Obstetrics because it is a (usually) happy specialty, and he gets his desire to do surgery met by the gynecologic surgical cases he has. Obviously not a lifestyle pick, but he does a pretty good job at balancing things.

Sally

[houseelf]

But, I have to say that I have borne the brunt of the whole thing, single-parenting three kids with little or no breaks and no money to hire help. Now he's talking about doing an away rotation for three months this spring! The requests for me to bend over backwards and be superwoman just never seem to end. I have learned (the hard way, of course) that I need to do things to take care of myself, and that helps immensely. But sometimes I can't help but wonder if things would be different if it were myself doing the residency and DH taking care of the kids. I feel guilty leaving him with them for too long -- isn't that nuts!?

Lunatic, I think that we are living parallel lives in different universes. I could have written this myself a few years ago. In fact, I think that I have posted this about four thousand times. (Currently I can't complain because we currently are enjoying a brief sanctuary during DH's two year stint in the research lab.)

We faced the decision after our first year here to leave this big academic program to go back home to our local community general surgery program. In the end, I decided that academic surgery was DH's deepest passion and I didn't want to bear the cross of making him forgo his dream for the rest of our marriage. I was afraid of what this would do to both of us.

Fast forward three years down the road...his career path has profoundly altered every nook and cranny of our life, from our debt load, to sex life, to parenting decisions. DH still plans on doing a fellowship in pediatric surgery after our seven years of gen. surgery residency. This is a fellowship which is notoriously difficult to attain (thus we go wherever we match with little regard to our preferences) and difficult to survive with usually only one or two fellows serving multiple hospitals.

Seriously, mentioning the word "fellowship" in our household will spur on full out marital war fare. Honestly, I don't want to give him an ultimatum about the fellowship, but I am honest when I say I don't know how much more our family can or should bear in terms of sacrificing for his career. Believe me, I could go on about this issue ad infinitum.

Seriously, dh's specialty and/or potential subspecialty comprise THE single biggest conflict in our relationship. Expecially if you consider these topics as part and parcel of the bigger theme of dh's inability to place some parameters, however small, on his professional life. We argue this same argument over and over. We can't get past it.

Don't get me wrong, DH loves his family immensely but feels like he isn't always capable of setting boundaries. It is hard to argue with a coding patient, a 7 hour surgery, blah, blah, blah. But slowly and surely, this profession erodes away at the family and an individual's self esteem and worth. Honeslty, we have been blissful in the lab but reading your post of commiseration makes every one of these feelings flood back with deep intensity. Not to be melodramatic, but I pray that this issue won't be the achilles tendon of our marriage.

Downloading this feels so very *****gooooood****. Ahhh.

Kelly

Definitely driven in my husband's case. He's always said that treating children was far more rewarding because they are so completely innocent and have the potential of a full life ahead of them. The hardest part about treating children is... the parents. And when children are in the hospital it is usually out of their control as to how they got there (especially if they have cancer) but with adults, many times it's because of poor choices (drunk driving, smoking 3 packs a day, bungee jumping, you get the idea). It's easier to treat a child when you're sleep deprived but it's harder to have patience with someone who's been in and out of the hospital because they can't control their drug and alcohol use when you haven't slept in two days.

But honestly, I think my husband's niche will eventually be in research. He got a PhD in Immunology and will start research in October and I can tell he will be in seventh heaven. Writing grants and figuring out the why and how of medical science is ultimately what he loves best.

[SueC]

In our case it is definitely due to my husband's passion for treating patients in the ICU. If it were a lifestyle choice, that would mean he must not like hanging around me and the kids much!
I felt very much like Kelly did about the whole thing--I really wanted to steer my husband towards general practice, but I didn't want to be the one to stand in the way of his dreams. When we were discussing which route to take, money wasn't a factor. I suppose he can make more as a specialist but then again that means we have to pay $265K in loans which would have been forgiven if he would have been a general practitioner in an underserved area. We decided that if he has to continue being a doctor (I did put my foot down on that one!) he might as well go into something that he really loves regardless of where that puts us financially. As far as lifestyle goes, I have this crazy idea that there is a pulmonology position out there that won't require my husband to spent half of his life at the hospital!

[DCJenn]

For my husband, the decision to do peds was visceral- He did the rotation and bam- that was it. Now that he's finished the peds residency, he is as committed or more to working with kids. Unfortunately for him, the fellowship requires one year of adult neuro which is keeping him away from pediatrics. He's pretty miserable but is learning quite a bit. Luckily, the call room is in the peds ward so he atleast gets to dip a toe in on the way to catch some 'zzzz's'.

The reason he decided to do the fellowship was partially lifestyle- in that the only way to even semi-control where you end up in the military is to specialize in an area that is only used at the large military hospitals. But that was the icing on the cake, more than the big decision-maker for him. He has always loved the neuro stuff, and it has a certain reserach level to it that he enjoys a lot, too. (when we were in the throes of "I hate peds, I hate people, I hate medicine" during internship year, he thought seriously of switching to pathology or radiology partially because they have that research quality to them)

The other nice thing about his foray in to peds neuro is that it dovetails very nicely with my career in developmental disabilities (or intellectual disabilities as they are now supposedly known). We have some no doubt exceptionally boring conversations about seizures and medications and Tardive Dyskenesia, etc. It is nice to call home with a medication regimine that I have questions about and run through diagnosis and medications and see if I have any need to do additional follow-up.

Jenn

Good post, Matt! I read this article a day or two ago and thought it was really interesting.
I chose "other" in response to the poll as none of the options were the clear-cut reason for the choice of specialty in our house. I do think that lifestyle can play a role in selection of specialty and I think that is a pretty understandable thing. Eric noticed that there were a lot of women interviewing for derm (either more women get interviews or more apply). Lifestyle is certainly a plus for that specialty.

Since we have chosen 2 different specialties in our house , we have beaten the dead horse of specialty selection from a few different angles.

The first time around, it was internal medicine. When DH was applying for residencies, I surprised myself by nagging him , to apply to ob/gyn. I just didn't think he would be happy with IM because there wouldn't be enough procedure type work. He loved his ob/gyn rotation, despite being treated horribly a good part of the time (one of the attendings hit him with an instrument during surgery! 8O ). I think he also felt guilty about choosing a specialty that could be more of a burden on our family. This concerned me (and is what pushed me to lobby for ob/gyn), that he would be unhappy with his choice and regret his decision. If he just absolutely loved it and had to do it, I think he would have gone ahead with ob/gyn (or maybe one of the surgical sub-specialties he liked). I think that he was thinking that he could specialize after IM, but the more procedure-intensive specialties weren't as interesting to him. Part of the issue was that he had a path for IM well laid out before him -- participation on a student board for a national IM organization, great letters, IM preceptorship for 3 years....I finally relented and quit nagging and he started his IM residency.

As luck would have it, he started his intern year with an ambulatory clinic month - -the first week of which was in derm. He had no prior exposure to derm and he *loved* it and talked about it constantly. As the misery of his intern year set it, he started to look into and pursue a derm research fellowship that would give him some derm research background and a better shot at applying for a hard-to-get derm residency. I think derm is a great fit for him: lots of procedures, get to know patients on a longer term basis in some cases, generally happy population (appreciate relief from uncomfortable or unsightly skin conditions). A HUGE plus is the lifestyle (not bad in residency, either) and a salary about double what a general IM makes (for now anyway). The lifestyle and money, though, would not be enough for him if he was grossed out by skin or found derm to be boring. And those two factors were certainly not enough for what we went through with re-applying. We haven't reaped the rewards of reserach time until last April, after the match. The stress level of internship continued well into the start of the derm fellowship because of the added stresses of -- dealing with the IM dept and him leaving the program (they weren't too happy about it), uncertain funding for the fellowship and a leap of faith there, applying for a hyper-competitive specialty, the cost of interviews and applications (no loans once you are out of school), waiting on pins and needles through the match, facing having to move to what could be a not-top-choice city (a minor, uh, miscommunication during application time ). (A bonus of IM was staying in our current state....downside of ob/gyn last time was almost certainly having to leave because he didn't like the programs here).

Ultimately, I feel like we made the right decision...that is certainly influenced by the fact that he did match in derm. I would rather have him work more hours and be happy with what he is doing that work fewer hours and be grumpy and regretting his career choices. The nice benefit for us is that he chose a speciality that is among the best for lifestyle.

For us it was a combination of lifestyle choice and then money. Originally Russ LOVED general surgery and that was the only rotation where his eyes would light up when he came home. I felt sick about it and yet knew he was good at it. He was planning on going the surgery route clear up until the October of his 4th year!!! 8O He did an out of state rotation in surgery and anesthesia. The only reason he did the anesthesia rotation was because he knew the anesthesiologists from undergrad and thought it would be a fun, easy month. He really liked the rotation and after working 100 plus hours a week for the month he did his general surgery rotation, he decided that anesthesia was the way to go for our family.

Money was a consideration for us though too because we are a bit older with older kids. Russ wanted a specialty where he could make pretty decent money to help pay off loans and catching up on college funds, retirement, FUN STUFF etc.

I was so relieved when he changed to anesthesia and glad he got in when he did. It is getting harder to get into anesthesia residencies now.

Robin

[PrincessFiona]

Robin...Wow...how the heck are you?? I haven't seen you in awhile!

Matt, interesting topic!!! Thomas decided on ID purely out of intellectual interest and the drive to know as much as possible in the field. It's been worth the bumpy ride to see him thriving in a field that is so interesting to him.

kris

Mike decided on FP because he likes having long-term relationships with his patients (the good ones at least). He's very much a people person, and I've seen him in action--it's a very good fit, especially with his older patients. If someone really wants to get better and be healthier, he'll fight to the ends of the earth for them.

It had better not have been lifestyle--which I'm finding is no better than residency on the "time we have together" front. When he takes rural and unassigned call, he's gone for 36 hours at a time, and that's in addition to his clinic hours (12 per day). I sometimes feel like Thoreau, alone in the middle of the woods with the dog and birds and my garden for company. I'm an independent introvert, but hey, sometimes it's a little much even for me. The money's okay for us--it allows me to stay home and do freelance writing and volunteer work, and our house is gorgeous. Of course, we only have $30K in loans after what the military paid, and neither one of us is a "conspicuous consumption" type, which helps...

After thinking about it for awhile...no one is going to say that my DW/DH got into ______ for the money. We all know money isn't made in medicine as it was in the past. I suppose that I was just curious about if it was a choice of having more family time (if it was an option!) or if said area was what makes them excited about medicine altogther.

Having said that, I also read an article recently about a Dr in the rural Northeast. I think it was Maine...not sure about it, and not able to locate the article now, of course! But she was FP and was working in solo practice. There was a breakdown of her income versus expenses, it was very interesting. After all was said and done she was making something between $30-$38K. Depending on her year. It was an article about PLI in the end because she was worried about her income after another raise in rates, she also did OB in her practice.

Just a little side note...
DW is working in the PICU this month, dealing with some very sad cases. She is completely enthralled and has had some of the best feedback from attendings since she has been at Children's Mercy. They have thrown the full-court press to recruit her for Intensivist fellowship. It is amazing to see her at her best even after 36 hour call days. She is absolutely happy and that makes me so very proud.