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If you were a med student today, would you go into derm or rads?
Assuming you’re competitive for both
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70 Replies
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Seems to me that Derm is at no less risk of AI encroachment than radiology, however small or large that risk is. I’d say ‘neither.’
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Rads, no question.
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I’d have a panic attack if I had to do what my spouse does every day.
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Quote from Glorfindel78
Assuming you’re competitive for both
thats an odd choice. can you still go NP?-
PE has decimated derm. Its run by all the slim, fit and good looking PAs and NPs now. So do derm if you want to meet your future trophy wife
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Most of the lucrative things in derm can be done by mid levels. Much of the field has been taken over by PE already and the now employed derms just supervise a gaggle of NPs each.
I would hate derm.
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Now polling re: rads, anesthesia, and derm? Any others you’d like to throw into the mix Glorfindel?
If these are legitimate inquiries, tell your kid to pick what he likes (maybe aside family med/peds). Don’t try to guess how things will be 10-30 years into the future.-
Medicine is such a disaster today. I have the feeling in 10 years, I will not even recognize this field.
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FP is actually a lot better these days, typically 4 day work week, little or no call- 250-350k, not too shabby???
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I always say we cannot predict the future, but at the moment
300k for 180 family practice shifts (assume no call) working 4 days a week and 6 weeks of vacation is roughly $1,600 per shift. No thanks.
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I’d rather look at bones than skin, so rads.
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I actually thought about derm , but just the thought bored me. Looking at skin of multiple people very day ….bored me.
Rads on the other hand is still exciting ! Cannot get bored. So, the choice still is obvious for me.-
Whatever you like better. Both could be great careers for the right person.
Radiologists get to do a little of everything, interact with everyone, and can earn a lot without having to build a practice. And you don’t have to look at skin all day, but you’ll have more anal play than you’d think
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I still think rads is the best specialty in medicine and wouldn’t choose another one.
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100% agree.
I switched last second to apply 22 years ago and it was kind of a spur of the moment thing, talk about good fortune.-
Derm is easily replaced by noctors for lucrative stuff, rads still not! And it will be a long time before AI replaces rads, so I’d say rads. But derms can and do charge cash which is an advantage. There is strong demand for both derms and rads.
So it is a wash.
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Quote from RoleCall
Whatever you like better. Both could be great careers for the right person.
Radiologists get to do a little of everything, interact with everyone, and can earn a lot without having to build a practice. And you don’t have to look at skin all day, but [u][b]you’ll have more anal play than you’d think[/b][/u]
[emphasis added]
Not speaking for myself, but for some that could be a positive…..
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Derm in some ways is like ER or primary care, the decision point of ordering tests/imaging in the ER versus punch biopsy in the derm clinic. A more experienced and confident physician can use their clinical acumen and judgement to avoid unnecessary tests based on clinical diagnoses. A less experienced NP/PA can just order the test and have a more advanced diagnostic modality guide their management. Ultimately it is the radiologist or pathologist that is conferring the actionable, real diagnosis. Punch biopsy is the CT CAP of derm.
And thus neither rads nor path can be infiltrated by midlevels since they are forced to make actual decisions and diagnoses in that chair.
Also, both are probably ripe for AI since there is a lot of imaging. I actually think derm is more so since taking a picture of a skin lesion and uploading it to an AI platform can spit out a differential which actually may be fairly accurate and if there is anything concerning in the differential the NP will do a punch biopsy.
Getting the more experienced clinician in this setting is to the benefit of the patient but everyone else is pissed off by it in our current health care system. The admin will be pissed off by the lack of revenue from lucrative pathology stains and punch biopsy procedure and interpretation billing, same as they are for unnecessary scans being avoided by ER docs. Hell even patients nowadays demand imaging and feel that getting testing, even unnecessary is better than doing nothing.
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I would choose IR>Derm>DR.
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IR is going the way of the dodo. Will be a separated from DR at most places in next 10-20 years. IR is not lucrative. IR has leeched off DR for a longtime. So sure it you want to make FP money do IR in the future
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DR is still king until if/when AI becomes far more advanced.
I don’t really believe AI will ever replace Rads, but could increase efficiency. But, keep in mind, volume of imaging studies is only going up and likely will continue in that trend for the foreseeable future.
So ultimately, for those of us in practice, AI may allow us to make even more money. -
Yeah I think the big risk here is if efficiency gains from AI outpace increasing volumes. IIRC, volumes only increase at about 5% per year in the US, so if we’re talking about AI doc reducing your time to read a CT PE by 80%, I could see seriously complications in the job market for the 1000 new grads every year.
Obviously the old partners will benefit -
Not a guarantee that older partners will benefit. If the training is in academics for AI and older partners are unwilling/don’t have energy to retrain: The new grads win.
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I just don’t see AI ever really reducing the time to interpret a PE study by 80%, ever. It’s probably a maximum of like 40% and then effectively 100% when it can completely read on its own and generate general diagnostic reports which go straight back to NP/PA without involving a rad. Like someone previously mentioned there is not a lot of fat to trim to make speed up a radiologists review of the images on a case before you are just not reviewing the case at all. Most of the 40% I think will be mainly report generation. 10% formatting, filling in the auto fields correctly (technique, contrast dose, radiation dose, etc). If it can generate a templated report with the common incidental stuff (aortic and coronary calcs, etc) filled out already based on the AI powered image interpretation, thats another 30% depending on how accurate. Beyond that you are trying to basically just take away actually looking at images which just isn’t gonna happen.
The odd thing to me though is the fact that I see in practice many places that have PACS inefficiencies, reporting software inefficiencies, techs not filling out the appropriate field for contrast and radiation dose so it can be auto inserted into powerscribe, etc. Like just switching to McKesson, buying the deluxe version of powerscribe 360 (and reverting back from PSone garbage), and making sure the techs case out studies correctly would probably give me a 40% efficiency increase, tomorrow. Doesn’t need AI or anything like that. Yet it doesn’t happen at most places. Why? It costs alot of money to buy these products and admin doesn’t care or understand how it works or helps. It’ll be the same with AI. Just cause AIdoc can increase efficiency even by 50% doesn’t mean your devry MBA administrator will buy it (and it is very expensive). -
Neither. I would get a MBA and work for PE to rollup derm and rad practices and skim off the top while collecting fees from LPs.
Derm has definely taken a hit over years with the penetration of midlevels and PE encroachment. You also need a certain mindset and entrepreneurial spirit to compete at the high end cosmetic market which most radiologists dont have. -
[size=”3″]You don’t ever see it reducing time to read a PE by 80% ever? Its happening right now, per a radiologist in a different post on this forum:[/size]
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[image]https://www.auntminnie.com/forum/app_themes/Classic/image/mIcons/m1.gif[/image]Re:What AI application are you actually using and find helpful? 07/06/23 04:15PM (permalink)
In reply to Sir Read Alot
[image]https://www.auntminnie.com/forum/app_themes/Classic/image/blank.gif[/image] [image]https://www.auntminnie.com/forum/app_themes/Classic/image/menuReply.gif[/image]Reply to message [/ul]AIDoc…Pretty good for ICH, PE, free air, pneumtx on xray, displaced rib fxs…PE is the best thus far, if neg for PE my time spent looking is like 80% less than normal…also it acts as a triage as these cases will come up as potential positives so at the very least, you have a chance to look at these studies sooner than later.
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And there are rads who blind sign on resident cases so having a resident effectively drops their review by 100%. It all depends on the rad. Would like to hear from other rads what their experience is. I think that is an overestimate based on the AI tools I have used.
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The AI I have tried has been trash imo.
The issue is that the hype over ChatGPT is overblown. ChatGPT actually is only really useful in certain use cases.
In fact, it is totally worthless in many areas.
So in Radiology it will be the same. There will be specific AI use cases that turn out to speed up our efficiency. But, not there yet. -
The AI I have tried is not good so far.
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Derm or rads.
Cracks me up.
Specialties at opposite ends.
Gross rashes and skin lesions. Endless OP office ours and trivial procedures.
Yuck.
Know thyself. -
Derm or rads.
Cracks me up.
Specialties at opposite ends.
Gross rashes and skin lesions. Endless OP office hours and trivial procedures.
Yuck.
Know thyself. -
An IR that can market himself and is able to practice in his own outpatient clinic/obl can do quite well. This has the benefit of avoiding the stress and call of the hospital.
Not to hard to start doing veins and biopsies in a medical office space. The most difficult part is the marketing and Insurance contracts. Very possible to achieve a radiologist salary doing this while working banker’s hours.
Doing more high end work (PAD, Embolization) can be quite lucrative, but have to go about setting up an OBL with high setup costs. Very similar to setting up a lucrative Derm practice. (buying lasers / fat freezing machines, etc).
DR is great for the passive personality types (just hand me some work to do). No marketing skills or significant emotional intelligence required. -
Agree !!
Yuck is correct. But boring also. And can be smelly and purulent and contagious, other than ugly. Yuck again.
Quote from boomer
Derm or rads.
Cracks me up.
Specialties at opposite ends.
Gross rashes and skin lesions. Endless OP office hours and trivial procedures.
Yuck.
Know thyself. -
Quote from boomer
Derm or rads.
Cracks me up.
Specialties at opposite ends.
Gross rashes and skin lesions. Endless OP office hours and trivial procedures.
Yuck.
Know thyself.
Agreed.
Whenever I hear someone is debating between these 2 they got knocked down a few pegs, red flag for hiring, etc.
They are so completely opposite it’s almost dead give away someone has no interest in the fields themselves, but that person is just trying to run a $, vaca, lifestyle, etc algorithm.
To each his/her own, but less likely to be someone you want to work with or be a good physician in my experience. -
If I could do it over, Id do ortho and fellowship in either trauma or sports.
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Not so sure IR kills it with an outpatient lab. Ya maybe the reimbursement per procedure is higher but the hassle of running an outpatient lab and the cost make it much h less profitable. Admittedly probably depends on location. Rural with higher reimbursement and more reliable staff probably can be done but in a city good luck
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Told my daughter not to do radiology and she is beginning her urology residency. If you like a taste of IR urology is a good specialty.
She tells her male patients her fingers are small.
Derm is BORING! -
I know one Rad who setup his own shop and is decently successful. He says money is not great but no hassles and he works for himself. -
A hardworking young man or woman in 2023 could go into medicine just for the money but I dont see happiness at the of that path. There are easier ways to make money. I think someone should want to be a physician – to work hard serving patients – and then the fact that you make an above average income should be a perk. If someone later would say to them , hey I have a 9 to 5 job, not nights or weekends, making PowerPoints and strategizing sales, and I make as much as you!.. they should be able to genuinely respond, yeah you make as much money for less work BUT I get to be a physician. For that person this is remains a great career.
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People don’t say stuff like that tho. There is still mostly high respect for physicians in society I feel, except dr Fauci lol -
When I interact with patients generally the experience is positive and they are mostly always respectful and thankful. Granted, being a Rad our viewpoint may be limited.
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Quote from Flounce
A hardworking young man or woman in 2023 could go into medicine just for the money but I dont see happiness at the of that path. There are easier ways to make money. I think someone should want to be a physician – to work hard serving patients – and then the fact that you make an above average income should be a perk. If someone later would say to them , hey I have a 9 to 5 job, not nights or weekends, making PowerPoints and strategizing sales, and I make as much as you!.. they should be able to genuinely respond, yeah you make as much money for less work BUT I get to be a physician. For that person this is remains a great career.
I appreciate your perspective but when you throw in the cost of medical education, under-payment during training, all the red-tape bureaucratic nonsense BS that practice entails, medical malpractice environment, never-ending CMS cuts, burn-out by increased volumes, PE infiltration/overlords, one has to be Gandhi to have this type of attitude -
I thinking being a physician should be a source of pride. -
Quote from Flounce
A hardworking young man or woman in 2023 could go into medicine just for the money but I dont see happiness at the of that path. There are easier ways to make money. I think someone should want to be a physician – to work hard serving patients – and then the fact that you make an above average income should be a perk. If someone later would say to them , hey I have a 9 to 5 job, not nights or weekends, making PowerPoints and strategizing sales, and I make as much as you!.. they should be able to genuinely respond, yeah you make as much money for less work BUT I get to be a physician. For that person this is remains a great career.
What are the easier ways to make money? Medicine has a high, reliable floor. Serious Q, don’t really want my kids have to deal with the stress of medicine *unless they are all about it. -
Quote from ChuckI
Quote from Flounce
A hardworking young man or woman in 2023 could go into medicine just for the money but I dont see happiness at the of that path. There are easier ways to make money. I think someone should want to be a physician – to work hard serving patients – and then the fact that you make an above average income should be a perk. If someone later would say to them , hey I have a 9 to 5 job, not nights or weekends, making PowerPoints and strategizing sales, and I make as much as you!.. they should be able to genuinely respond, yeah you make as much money for less work BUT I get to be a physician. For that person this is remains a great career.
What are the easier ways to make money? Medicine has a high, reliable floor. Serious Q, don’t really want my kids have to deal with the stress of medicine *unless they are all about it.
At this point this still stands. Specialists more or less are guaranteed to make 400-500K unless locked into a major coastal city. I do not know of any field that has an equally high reliable floor. Of course the work/stress is increasing. The costs of medical education and everything is increasing while reimbursement continues to plummet. Unless there is some meaningful CMS reform, things may vastly be different 5 years from now where everything is 10% more expensive and reimbursement is down 10-20% -
Dentistry is not a bad alternative. 4 yrs dental school with only a year or 2 of training afterwards, with similar income, less stress, no weekends or emergencies, depending on how your practice is set up, and less dependent on CMS. Lot of cosmetic out of pocket opportunities (orthodontics, for example), which puts you in a whole other echelon but requires more training. This is especially a nice option if you are not wanting to be the bread winner in the family or want to be part time.
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Btw. Plenty of happy internists and FPs in this world. They don’t work for a hospital or corporate but run their own 3-5 man practice, maybe a few PAs. Play golf on wed, call only for your practice a week at a time.
Move to a wealthy town. Rent a small office suite, open a fee for service medicare opt-out practice. Market yourself as specializing on ‘executive health’ and make good money managing the chronic health issues of those who don’t have time to sit in some corporate clinic waiting room.
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Radiology all the way.
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Agree that medicine remains a good career in terms of the “high reliable floor” for income. So that makes it a good career, period. But given the (to quote jd4540) “cost of medical education, under-payment during training, all the red-tape bureaucratic nonsense BS that practice entails, medical malpractice environment, never-ending CMS cuts, burn-out by increased volumes, PE infiltration/overlords”… it is pretty stressful and leads a lot of rads to come onto this forum and complain. Hence my feeling that for someone to really feel this is a great career and not just a profitable one, they should really be in it for the service and patient care, which I agree is a tall order. If someone really wants to be a physician for the negatives that entails, then earning above average income is just icing on the cake.
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Medicine is still a guaranteed path to a well paying job. Nothing else offers that guarantee. Yes, there are plenty of computer engineers who (after stock options) make neurosurgeon money, but they also work neurosurgeon hours. Yes, there are investment bankers, hedge fund bros who rake it in, but there are 10x as many people with finance degrees who barely break surgical PA money by selling whole life policies or in a mid-level management position at a local bank.
The ‘oh I wouldn’t want my kids to do medicine’ folks have blinders on. They run into the top 10% of their respective fields (law / finance / tech) in their social circle / country club / travel and mistake them for a representative sample. -
Agree with FW above. If you pick your field carefully, medicine remains an excellent career choice.
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Good points. I saw recently that top engineers at places like NFLX make $900K+ (that’s like 10 years in I think). Getting to that level is obviously not a very high percentage. So, I’m not calling that easy money. But could be alternative to becoming an ortho and making the same (not an easy path either).
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Technology is not a stable industry relative to health care. Technology is a boom / bust cycle and people lose jobs quickly when the tide goes out.
Medicine and health care in general is a very stable industry and has high recession resilience.
There are not many jobs as stable as being a doctor with $500k plus income potential. It is an excellent career choice for a “smart kid” so to speak. -
When the population of the world drops dramatically after the plan of scam in the 2020s, medicine won’t be good for a 10 year period or so. Going into medicine now is silly, if they keep all the requirements up, which they will, until the old system collapses, which it is currently.
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DreamRun have you taken a new fangled psychedelic? I’m interested in having some if you have.
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Quote from TripleJumper
DreamRun have you taken a new fangled psychedelic? I’m interested in having some if you have.
Yes, I can direct you to logic, facts and conclusions. PM me (-: -
Anyone have opinions on Heme-Onc? Seems like a solid, rewarding, and well compensated field. Also pretty resilient to both midlevels and AI
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The way I look at it, I have to do this career for 25-30 years. Being interested in the subject and liking or at least tolerating the day-to-day work is far more important to me than earning an extra x$/year. I don’t really have a want for things above and beyond middle class things. I don’t want a fancy car. I don’t want a boat or a large house. I am not trying to be better than anyone else, just for me those things do not bring any real value to my life. What does bring value to my life is being intellectually and emotionally stimulated by my work; or on the flip-side, not being beat down to a pulp emotionally by my work.
I think Hem-Onc is a super interesting subject. On the other hand, I don’t think I would do well with having to counsel people for 25 years about an often deadly disease. I do not want to be telling people to get their affairs in order. Maybe I am a wimp this way, but no thanks. If I practiced Oncology for 25 years I am afraid of the person I think I might become. You could pay me 2 million a year and I wouldn’t do it. But I am grateful there are people who choose to do it and are good at it.
I would recommend choosing the field of medicine that interests you the most. I would also imagine, all things considered, talking to yourself 20 years down the line and ask your future-self: “How often do you wake up in the morning and think, ugh, work again.” Get the “Ugh”-factor as low as possible. -
Quote from TripleJumper
The way I look at it, I have to do this career for 25-30 years. Being interested in the subject and liking or at least tolerating the day-to-day work is far more important to me than earning an extra x$/year. I don’t really have a want for things above and beyond middle class things. I don’t want a fancy car. I don’t want a boat or a large house. I am not trying to be better than anyone else, just for me those things do not bring any real value to my life. What does bring value to my life is being intellectually and emotionally stimulated by my work; or on the flip-side, not being beat down to a pulp emotionally by my work.
I think Hem-Onc is a super interesting subject. On the other hand, I don’t think I would do well with having to counsel people for 25 years about an often deadly disease. I do not want to be telling people to get their affairs in order. Maybe I am a wimp this way, but no thanks. If I practiced Oncology for 25 years I am afraid of the person I think I might become. You could pay me 2 million a year and I wouldn’t do it. But I am grateful there are people who choose to do it and are good at it.
I would recommend choosing the field of medicine that interests you the most. I would also imagine, all things considered, talking to yourself 20 years down the line and ask your future-self: “How often do you wake up in the morning and think, ugh, work again.” Get the “Ugh”-factor as low as possible.
Good points…Ultimately this is a leap of faith. One can chose a field for the “wrong” reasons and have a fulfilling career with the flip side also true. So many random variables at play….If the quality of rads jobs was similar to when I started in 2013, I would have left the field. -
But the problem with “do what you like” is the fact that you don’t know what you like unless you do it for a reasonable amount of time and that means almost end of residency.
I am sure that most medical students’ interest in a field is not based on true interest and is usually heavily biased by other factors.
I didn’t like Nucs in my residency and I didn’t do it in the first few years of private practice. However I was kind of forced to do it at some point and now after a few years of doing it I really enjoy it which is even surprising to me.
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Yes I agree.
There is no real way to know what you like in medical school. By the time you figure out all your passwords and what the names of your supervising residents are and what the lecture schedule is, your 3-6 rotation is over.
I always thought there should be more exposure to real-world doctors in med school. It would have been nice to have some “lectures” from real-world doctors where there is no grade and no test and the doctors just tell the unvarnished truth – the pros and cons – of their specialty. That would have benefited me way more than histology lab where I was naming what different color blobs on a microscope slide were called. -
If real world doctors gave lectures, than your biochem professor couldn’t spend an afternoon teaching a hundred plus people about (and later testing) his obscure research.
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Quote from ChuckI
If real world doctors gave lectures, than your biochem professor couldn’t spend an afternoon teaching a hundred plus people about (and later testing) his obscure research.
Yes, Chuckl, we actually had this happen at a prominent med school when I was there decades ago. A big picture doc came in and (I think it was mostly anatomy) basically just No BS-d everyone and said “this is basically what you need to know” and it rained on the parade of making things hard just because. The funniest part about it is that the school was literally pass-fail!
TripleJumper, I agree, and often say that I wouldn’t risk med school again not so much for what I ended up doing (got lucky), but rather that the odds of me matching my specialty were not odds I’d take again, because there’d be too high a probability that I wouldn’t pull that off in a “different life.” And I hated most of the other specialties, and thought most rotations were a joke. Med school should also be 3 years.
The real issue is that we have a systems problem. Even in most specialties, if you still like yours at this point, it’s made horrible by the ball and chain, the EMR system, the notes, the bureaucracy, the C suites grifting … ugh -
My longer posts always get Forbidden 403 so I will shorten. Medical education could be condensed from 8 (4 ugrad +4 med) into 5 years. Radiology training could be condensed from 6 (1 + 4 + 1) to 4 years (integrated internship and fellowship). Attending at age 27 instead of 32. Save a ton of resources, less debt.
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Similar to the rest of the world.
Quote from ChuckI
My longer posts always get Forbidden 403 so I will shorten. Medical education could be condensed from 8 (4 ugrad +4 med) into 5 years. Radiology training could be condensed from 6 (1 + 4 + 1) to 4 years (integrated internship and fellowship). Attending at age 27 instead of 32. Save a ton of resources, less debt.
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Quote from Glorfindel78
Anyone have opinions on Heme-Onc? Seems like a solid, rewarding, and well compensated field. Also pretty resilient to both midlevels and AI
There was a time PP heme-onc were making bank. This is when they made a good skim on self referred chemo and imaging. The feds put an end to it.
90% of your patients are not dying while you are dealing with them. Breast, lung, colon consults are your bread & butter. Once you are on the third line chemo and things are going south you hand them to hospice anyway.
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Quote from boomer
Derm or rads.
Cracks me up.
Specialties at opposite ends.
Gross rashes and skin lesions. Endless OP office hours and trivial procedures.
Yuck.
Know thyself.
Amazingly (to me at least), derm is a 3 year(?) residency to learn the following:
[ol][*]If it’s wet, dry it. [*]If it’s dry, wet it. [*]If neither of those work, try steroids. [*]If you know what it is, don’t touch it. [*]If you don’t know what it is, FOR GOD’S SAKE don’t touch it. [/ol]
In med school I got farmed out to a PP derm’s office for a day. Found that the House of God comment on derm was true regarding pros/cons of derm: “Pro: Naked skin = turn on. Con: Naked skin = turn off.” Also was incredibly bored after the first hour. However, even as a greenhorn med student, I could figure out the guy was running a gold mine. He saw the patient on initial consult, did the procedure, did the derm-path, then saw the patient at followup.
Found (and still find) rads much more interesting and after my 3rd year rotations found out that it really wore me down to deal with sick people, and especially those who don’t want to get better. I know, I know…. then why the eff did I go to med school? What can I say except that I was young, naive and thought I knew myself better? At least I figured it out early and a specialty like radiology exists.
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[b]Private equity-backed healthcare services bring more harm than good to patients, report reveals[/b]
[link=https://healthexec.com/topics/healthcare-management/private-equity-backed-healthcare-services-bring-more-harm-good-patients-report-reveals]https://healthexec.com/to…atients-report-reveals[/link]
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Quote from PirateRad
[b]Private equity-backed healthcare services bring more harm than good to patients, report reveals[/b]
[link=https://healthexec.com/topics/healthcare-management/private-equity-backed-healthcare-services-bring-more-harm-good-patients-report-reveals]https://healthexec.com/to…atients-report-reveals[/link]
While I really dislike PE, have to lay a large part of the blame on CMS for their emergence. If we weren’t getting slaughtered by cuts there would be no need to sell out to PE -
Quote from Glorfindel78
[size=”3″]You don’t ever see it reducing time to read a PE by 80% ever? Its happening right now, per a radiologist in a different post on this forum:[/size]
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[image]https://www.auntminnie.com/forum/app_themes/Classic/image/mIcons/m1.gif[/image]Re:What AI application are you actually using and find helpful? 07/06/23 04:15PM (permalink)
In reply to Sir Read Alot
[image]https://www.auntminnie.com/forum/app_themes/Classic/image/blank.gif[/image] [image]https://www.auntminnie.com/forum/app_themes/Classic/image/menuReply.gif[/image]Reply to messageAIDoc…Pretty good for ICH, PE, free air, pneumtx on xray, displaced rib fxs…PE is the best thus far, if neg for PE my time spent looking is like 80% less than normal…also it acts as a triage as these cases will come up as potential positives so at the very least, you have a chance to look at these studies sooner than later.
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[size=”3″]And looking for a PE is about 20% of the work involved in reading that study. At least 95% of the time, it’s not a PE. [/size]
[size=”3″] So, no, it doesn’t reduce reading time by 80%.[/size]
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