Specialty Stories

Session 5

In this week's episode, Ryan talks with an orthopedic hand surgeon in a hybrid setup. He's in a community-based hospital and program but he has residents he interacts with who rotate through the hospital. He has been practicing for almost two years.

Here are the highlights of the conversation with Ragu: When he knew he wanted to be an orthopedic hand surgeon:

• Deciding he wanted to be an orthopedic surgeon towards the end of 2nd year medical school
• He chose hand surgery towards the middle of his orthopedic residency after doing some rotations and liking the intricate nature of the hand

What led him to orthopedics vs. general surgery:

• Enjoying the aspect that you focus on the extremities
• It's a specialty with multiple subspecialties - (ex. sports, joint replacements, shoulder, knee, hand, children) so it gave him a lot of options
• General surgery is like a primary care field with no cross-correlation for orthopedics.

Other specialties he was considering:

• Anesthesia
• Radiology
• EENT

Traits that lead to being a good orthopedic surgeon:

• Hardwork
• Dedication
• Desire to work with your hands and doing procedures
• Good motor coordination

A typical day for an orthopedic:

3 days of office

• 1 1/2 days of surgery
• 1/2 administrative work or extra surgery

Office day:

• 8am - 4pm seeing 20 patients
• 20 minutes per patient + 5 minutes to do charting
• Consultations on the floor in between
• Answering calls from patients
• One weekend per month of call

Surgery day:

• 7:30 am to 3-4pm doing 3-6 surgeries a day (depending on the type and length of surgery)
• 75-80% of his surgeries are hand/upper extremity surgeries (hand, wrist, forearm, elbow)
• *Majority of hand surgeons do only hand surgery (90-95%)
• *The average orthopedic surgeon takes 5-6 days of call a month (1 weekday a week and 1 weekend for the month)

Types of patients and cases an orthopedic sees:

• Carpal tunnel syndrome
• Tendonitis
• Hand fractures/injuries
• Traumatic injuries (lacerations on the hand)

Percentage of patients he sees in the office that he ends up taking in the operating room:

1-2 out of 20 people that he sees

Does he have work-life balance?

• He is married and travel once every 3-4 months for a vacation.
• He has a number of hobbies outside of work like basketball and golf.
• Quality time with his wife, friends, and family
• You have a good chance of having a say on who you want to set up your life because you get to pick and choose what is important to you.

What makes a competitive applicant for orthopedics:

• Showing interest in orthopedics (talking to the orthopedic department in your school and talking to some people) and getting involved such as research or lectures
• Good board scores
• Good letters of recommendation
• Good scores on clinical rotations especially those involving surgical stuff (surgery, OB, medicine)

Bias in the orthopedic field towards DO applicants:

In the past, DO applicants were not getting proper consideration. But in the recent years, DOs are starting to get more recognition as being just as competent as MD applicants.

Generally, there is a slight bias against DO applicants applying to MD orthopedic programs.

Residency as an orthopedic surgeon:

• Tough but every year gets better
• He enjoyed it a lot.

Duration:

• 1 year general surgery intern year (half doing orthopedics and half doing general surgery with a potential for a month of elective such as radiology)
• 4 years of orthopedic-only residency

What the orthopedic fellowship looks like:

• 1 year (Others do second year on a different fellowship)
• Orthopedic fellowships are cyclically competitive (every 4-5 years, there's a new, popular fellowship that everybody wants to get into)

Opportunities for females to enter orthopedics:

• There are many females in orthopedics.
• Women can be just as good as men in orthopedic surgery and can do any subspecialty they want. It's just a matter of knowledge and training.
• More and more women are now going into orthopedics and there are now more and more women in orthopedics doing fellowships.

What the orthopedic board exams look like:

• Similar to USMLE only that it's focused on orthopedics
• Multiple choice questions - Parts I and II
• Part I - Test for knowledge of the basic science and orthopedic surgery
• Part II - Oral exam

How the oral exam works:

• Once you're out in practice, you submit 6 months worth of your surgical cases.
• They will review them and pick a number of cases then you discuss it with senior orthopedic surgeons.
• They will ask you numerous questions and they will judge you based on your clinical decisions.

Pass rates for the board exams:

• Part I - US medical graduate from a US orthopedic residency: low 90% range
• Part II - low 90% range

What he wished he knew before starting his orthopedic residency:

• Knowing that time passes by quicker than you think.
• Opportunities don't come about again once you finish your training.
• The whole goal of residency is to see and learn as much as you can.
• You have to go in prepared for those first 2-3 years of residency to miss important life events and not feel bad about it. After that time, things will be easier.

What he wished primary care physicians knew about orthopedics:

Orthopedics are capable physicians and they do and understand some medicine. Hopefully, more of them would give them some credibility in regards to that.

If primary care physicians would take a little bit of initiative to learn the musculoskeletal exam or the basics of it, they can actually examine their patients and be able to direct them to an orthopedic surgeon appropriately instead of just sending them without even having seen the patient.

Other specialties orthopedics work the closest with:

• Emergency room physician or PA
• Internal medicine team
• Rheumatology and Neurology

Other special opportunities outside of medicine:

Research and development of orthopedic implants and products (such as bone cements)

What he likes the most about being an orthopedic surgeon:

Seeing and interacting with patients and giving a solution to a problem that's been plaguing them for months or years

What he likes the least being an orthopedic surgeon:

• Being on call (ex. getting a phone call at 2 am)
• The few patients that are beyond his ability to help

Would he still have chosen orthopedic hand surgery if he had to do it all again?

Yes, because he likes orthopedics and hand orthopedics.

The future of orthopedic surgery:

Figuring out ways to heal the body and improve things without surgical intervention like lasers or nanobots to make the human body better.

The immediate future of orthopedic surgery:

1. They have improved their ability to fix people's broken bones by making smaller incisions and using sturdier implants.

1. They have gotten better with the biologics of bone so they are able to stimulate the bone properly so it heals faster and stronger.

1. They have figured out how to treat tendonitis without traumatizing them with surgery but by way of stem cells or platelet-rich plasma, etc

1. The use of robotics

Some pieces of advice for students interested in orthopedic surgery:

• Don't be daunted by the competitiveness of orthopedics. It's not as bad as people make it out to be to get in.
• Just decide what you want to do and go for it.
• Don't decide on orthopedic surgery for the money, fame, or popularity.
• Look inside yourself and decide on what's going to make you happy. Pick a specialty you can be happy doing 15-20 years down the line. That's what's going to keep you going to work everyday And that's what's going to keep you happy with your work and home life and give you the most success.

Links and Other Resources:

www.mededmedia.com

www.OldPreMeds.org

Session 4 In this episode, Ryan talks with Dr. Patrick Pickett, an anesthesiologist who practices in the community hospital in Oklahoma as he shares about his path to anesthesiology, his typical day at work, work-life balance, as well as the things that he like most and least about being an anesthesiologist. Finally, he gives his opinion on the future of anesthesiology specifically merging with CRNAs.

Here are the highlights of the conversation with Patrick: Choosing the kind of setting to practice in: Always thinking he wanted to do academics

Realizing he didn't want to do academic setting after doing a fellowship in critical care medicine

Started looking for jobs and happened to find a community job and realized it was a better fit for him

When he knew he wanted to be an anesthesiologist: Patrick majored in engineering and volunteered at a biomedical engineering department at a hospital and realized it wasn't something he wanted to do.

Getting to watch surgeries and working with the anesthesia side of it

Went through shadowing and didn't like it but after going through rotation and training, he had a turnaround

What caused him to like anesthesiology after rotation: Coming from a family with medical background, he knew what specialties he didn't like

Thinking he wanted radiology coming into medical school

Not liking clinic and liking hospital setting

Liked being in the operating room but not liking to be a surgeon

Choosing the specialty through the process of elimination

Traits that lead to being a good anesthesiologist: Flexibility in time and treatment options

Thinking on your feet

Being well-versed and liking different things

Having broad knowledge

Being able to change gears quickly

Being able to get along with people and the team

Being able to assume leadership role at times

A typical day in the say of an anesthesiologist: Starting before 7 am and ending the day 4-5 pm on average

There is no one typical day since you will be working at different locations for different cases

If in the operating room: 3-5 cases on average for 1-2 hours each

If in the GI lab: 10-15 cases for 30 minutes each

If in neurosurgery/spine surgery/cardiac: 1-2 cases for 4-8 hours each

If in general surgery:

Meets with patients; talks about the plan, risks, and alternatives and then to the operating room

Walks patients through the procedure to reduce anxiety; manages vital signs, making sure all things are in place

At the end of the surgery, takes them to the recovery room

Taking calls: Less frequent calls but more likely to go to the hospital to be there

Work-life balance: Yes.This is one of Patrick's pre-requisites in choosing a specialty because he wanted something that would give him some flexibility.

55-60 hours a week

Some days are predictable so he gets to see his kids more.

Being on call is part of the deal but it's manageable.

What makes a competitive applicant for anesthesia: It's almost like Emergency Medicine in terms of the board scores and the grades

Intangible aspect: Being appropriately aggressive, knowing when to step back and when to step forward to help out

Doing well in your rotations

It's not a small field as there are many programs in anesthesiology (around 1500 spots)

What residency looks like: 4 years - Intern year (medicine, surgery, EM, ICU, etc.) + 3 years (general rotations)

Most programs won't put you in the OR by yourself on day 1 of that 2nd year

More independence and advanced rotations as you go along

Pain management as a multidisciplinary field in anesthesiology similar to critical care

Less calls than surgeons but more than some others and almost always in-house and they couple a senior and a junior on-call

Orals boards: 2 hours

2 rooms (an hour each room and with 2 examiners in each room)

Each candidate has the same stem of the case but which direction each goes is up to the examiners.

It probes the...

Session 4

In this episode, Ryan talks with Dr. Patrick Pickett, an anesthesiologist who practices in the community hospital in Oklahoma as he shares about his path to anesthesiology, his typical day at work, work-life balance, as well as the things that he like most and least about being an anesthesiologist. Finally, he gives his opinion on the future of anesthesiology specifically merging with CRNAs.

Here are the highlights of the conversation with Patrick: Choosing the kind of setting to practice in:

• Always thinking he wanted to do academics
• Realizing he didn't want to do academic setting after doing a fellowship in critical care medicine
• Started looking for jobs and happened to find a community job and realized it was a better fit for him

When he knew he wanted to be an anesthesiologist:

• Patrick majored in engineering and volunteered at a biomedical engineering department at a hospital and realized it wasn't something he wanted to do.
• Getting to watch surgeries and working with the anesthesia side of it
• Went through shadowing and didn't like it but after going through rotation and training, he had a turnaround

What caused him to like anesthesiology after rotation:

• Coming from a family with medical background, he knew what specialties he didn't like
• Thinking he wanted radiology coming into medical school
• Not liking clinic and liking hospital setting
• Liked being in the operating room but not liking to be a surgeon
• Choosing the specialty through the process of elimination

Traits that lead to being a good anesthesiologist:

• Flexibility in time and treatment options
• Thinking on your feet
• Being well-versed and liking different things
• Having broad knowledge
• Being able to change gears quickly
• Being able to get along with people and the team
• Being able to assume leadership role at times

A typical day in the say of an anesthesiologist:

• Starting before 7 am and ending the day 4-5 pm on average
• There is no one typical day since you will be working at different locations for different cases
• If in the operating room: 3-5 cases on average for 1-2 hours each
• If in the GI lab: 10-15 cases for 30 minutes each
• If in neurosurgery/spine surgery/cardiac: 1-2 cases for 4-8 hours each

If in general surgery:

• Meets with patients; talks about the plan, risks, and alternatives and then to the operating room
• Walks patients through the procedure to reduce anxiety; manages vital signs, making sure all things are in place
• At the end of the surgery, takes them to the recovery room

Taking calls:

Less frequent calls but more likely to go to the hospital to be there

Work-life balance:

• Yes.This is one of Patrick's pre-requisites in choosing a specialty because he wanted something that would give him some flexibility.
• 55-60 hours a week
• Some days are predictable so he gets to see his kids more.
• Being on call is part of the deal but it's manageable.

What makes a competitive applicant for anesthesia:

• It's almost like Emergency Medicine in terms of the board scores and the grades
• Intangible aspect: Being appropriately aggressive, knowing when to step back and when to step forward to help out
• Doing well in your rotations
• It's not a small field as there are many programs in anesthesiology (around 1500 spots)

What residency looks like:

• 4 years - Intern year (medicine, surgery, EM, ICU, etc.) + 3 years (general rotations)
• Most programs won't put you in the OR by yourself on day 1 of that 2nd year
• More independence and advanced rotations as you go along
• Pain management as a multidisciplinary field in anesthesiology similar to critical care
• Less calls than surgeons but more than some others and almost always in-house and they couple a senior and a junior on-call

Orals boards:

• 2 hours
• 2 rooms (an hour each room and with 2 examiners in each room)
• Each candidate has the same stem of the case but which direction each goes is up to the examiners.
• It probes the limits of your knowledge and the format can be intimidating.
• Written board exam first before taking the oral exams
• Not a question of content but about being able to think on your feet

Bias among DOs vs. MDs:

Any bias perceived is not deserved.

Sub-specialties:

1. Pain management:

• Neurologist
• Psychiatrist
• PMnR
• Internal Medicine

1. Critical Care:

• ICU medicine

1. Other sub-specs:

• Pediatric anesthesia
• Cardiac anesthesia > echocardiography
• Obstetric anesthesia
• Liver transplant anesthesia

What he wished he knew going into anesthesiology that he knows now:

• Job opportunities available
• The business side of medicine

Other specialists he works the closest with:

• All surgical fields expanding to procedural fields such as:
• GI - endoscopy
• Cardiology
• Internal radiologist
• MRI (they may provide sedation for really young patients)

Special opportunities outside of clinical medicine:

• Expert witness testimony
• Research
• Quality improvement
• Expansion of training
• Quality management

What he wished other specialties knew about anesthesiologists:

• Their focus on safety particularly a combination of three:
• Patient and their medical problems
• The surgery and how it affects the body
• The anesthetic and how it affects the body
• They have different ways of looking at patients.
• Pre-anesthesia process to decide who's a good candidate and who's not and what they can do to make them a good candidate
• They try to get everybody on the same page.

What he likes most as an anesthesiologist:

• Variety of the things they do everyday
• They also have their share of excitements but he also likes the routine stuff

What he likes the least being an anesthesiologist:

Night calls

Would he still choose anesthesiology if he were to do it again?

Yes, it's the right fit for him. You have to go through it to find out what works for you.

The future of anesthesiology vs. CRNA's merging:

The Anesthesia Care Team is a very safe approach. Patrick finds that although the topic is controversial, most people working get along just fine.

For premeds, you should be prepared to supervise nurses and you should be prepared to do your own cases because you can do both.

Some pieces of advice for those considering anesthesiology for a specialty:

If you like the fast-paced hospital-based specialty, give it a try. Give it a rotation and if you don't like it, there are plenty other fields to choose from but if you do, it can be a great career.

Links and Other Resources:

www.mededmedia.com

Session 03 In this episode, Ryan talks with a neurologist, Dr. Allison Gray, as they discuss all things about neurology. Notice that Ryan follows a standard regimen of questions in his episodes so you can compare each of the answers to hopefully help enlighten you in choosing your residency.

Allison is working as a neurologist at a large medical group in a community setting in Colorado.

Here are the highlights of the conversation with Allison: When Allison knew she wanted to pursue Neurology: Getting fascinated at neuroscience

Her father being a neuropsychologist

Why community versus academic: Being drawn more to clinical practice

Types of patients: Of all ages - teenagers and up (Pediatric Neurology is a separate specialty with a separate board of accreditation)

Fairly healthy and dealing with chronic conditions like migraine

People very debilitated by acute neurologic problem like stroke or chronic problem like ALS

A typical day in the life of Allison: 8am - 5pm

Sees 10 patients a day (This is a lot for neurologists since they have long examinations and they take long histories.)

Breakdown of her 10 patients-

6 new consults

1 procedure (ex. EMG)

4 follow up visits

On work-life balance: Where she works has emphasis on creating work-life balance

Flexibility in setting her schedule

Work-life balance is a challenge for her being a mom

Getting amazing support from staff who let her do physician work because they take as much administrative stuff off her plate as possible

Traits that lead to being a good neurologist: Being cerebral (focusing not just on what the problem is and the best treatment, but where the problem is)

Interest in solving a puzzle

Being able to dive into action quickly (ex. stroke patient)

What makes a competitive applicant for neurology: Getting better grades

Getting good board scores

Depends on geography (Neurology as a whole is not as competitive as orthopedic surgery or radiology)

Good shadowing experience

Find a way to participate in a neurology elective

Is matching competitive for Neurology? Middle range - It depends on geography and whether you're going to a very competitive program at a big name institution.

Do you see any bias between MDs and DOs for Neurology? None that she's aware of.

What is residency like for Neurology? Her residency was volume-heavy and she was seeing a great deal of patients

Great in-patient heavy doing a lot of in-patient rotations in stroke and acute neurology and Neuro-ICU

Out-patient time depends on the academic institution

Residency is 4 years (1 year of Internal Medicine and 3 years of Neurology residency)

What she wished she knew going into Neurology? Appreciating that Neurology was sad sometimes considering there is still no good treatments for Alzheimer's, Dementia, ALS, etc. So you see people facing very devastating illnesses that are chronic, debilitating, and even deathly. Also, Neurology is acutely devastating sometimes. It really takes guts to see someone suffering.

However, Neurology has a great promise and they're seeing wonderful new therapies coming out. Compared to 20 years ago, now there's a huge difference in the way they treat things like MS and genetic disorders.

What do you wish primary care providers knew about Neurology? Neurologists are here to help and they're happy to help primary care physicians and they can always ask for help.

Specialties she works the closest with: Neurosurgeons

Orthopedic surgery

Spine clinic

Physical therapy

Special opportunities outside of clinical medicine for Neurology: Working with industries to discover new treatments

What Allison likes most about being a Neurologist: A wide variety of problems in a day

She enjoys helping people and their families in difficult situations.

What she likes least about being a Neurologist: The difficulty in not being able to offer someone something to fix a problem

Would she have chosen...

Session 03

In this episode, Ryan talks with a neurologist, Dr. Allison Gray, as they discuss all things about neurology. Notice that Ryan follows a standard regimen of questions in his episodes so you can compare each of the answers to hopefully help enlighten you in choosing your residency.

Allison is working as a neurologist at a large medical group in a community setting in Colorado.

Here are the highlights of the conversation with Allison: When Allison knew she wanted to pursue Neurology:

• Getting fascinated at neuroscience
• Her father being a neuropsychologist

Why community versus academic:

Being drawn more to clinical practice

Types of patients:

• Of all ages - teenagers and up (Pediatric Neurology is a separate specialty with a separate board of accreditation)
• Fairly healthy and dealing with chronic conditions like migraine
• People very debilitated by acute neurologic problem like stroke or chronic problem like ALS

A typical day in the life of Allison:

8am - 5pm

Sees 10 patients a day (This is a lot for neurologists since they have long examinations and they take long histories.)

Breakdown of her 10 patients-

• 6 new consults
• 1 procedure (ex. EMG)
• 4 follow up visits

On work-life balance:

• Where she works has emphasis on creating work-life balance
• Flexibility in setting her schedule
• Work-life balance is a challenge for her being a mom
• Getting amazing support from staff who let her do physician work because they take as much administrative stuff off her plate as possible

Traits that lead to being a good neurologist:

• Being cerebral (focusing not just on what the problem is and the best treatment, but where the problem is)
• Interest in solving a puzzle
• Being able to dive into action quickly (ex. stroke patient)

What makes a competitive applicant for neurology:

• Getting better grades
• Getting good board scores
• Depends on geography (Neurology as a whole is not as competitive as orthopedic surgery or radiology)
• Good shadowing experience
• Find a way to participate in a neurology elective

Is matching competitive for Neurology?

Middle range - It depends on geography and whether you're going to a very competitive program at a big name institution.

Do you see any bias between MDs and DOs for Neurology?

None that she's aware of.

What is residency like for Neurology?

• Her residency was volume-heavy and she was seeing a great deal of patients
• Great in-patient heavy doing a lot of in-patient rotations in stroke and acute neurology and Neuro-ICU
• Out-patient time depends on the academic institution
• Residency is 4 years (1 year of Internal Medicine and 3 years of Neurology residency)

What she wished she knew going into Neurology?

Appreciating that Neurology was sad sometimes considering there is still no good treatments for Alzheimer's, Dementia, ALS, etc. So you see people facing very devastating illnesses that are chronic, debilitating, and even deathly. Also, Neurology is acutely devastating sometimes. It really takes guts to see someone suffering.

However, Neurology has a great promise and they're seeing wonderful new therapies coming out. Compared to 20 years ago, now there's a huge difference in the way they treat things like MS and genetic disorders.

What do you wish primary care providers knew about Neurology?

Neurologists are here to help and they're happy to help primary care physicians and they can always ask for help.

Specialties she works the closest with:

• Neurosurgeons
• Orthopedic surgery
• Spine clinic
• Physical therapy

Special opportunities outside of clinical medicine for Neurology:

Working with industries to discover new treatments

What Allison likes most about being a Neurologist:

• A wide variety of problems in a day
• She enjoys helping people and their families in difficult situations.

What she likes least about being a Neurologist:

The difficulty in not being able to offer someone something to fix a problem

Would she have chosen Neurology if she had to do it all over again?

Yes, Allison thinks the brain is the most fascinating thing in the human body because it defines who we are as people and human beings.

Sub-specialty opportunities for a Neurologist:

• Epileptologists
• Neuromuscular specialists
• Behavioral neurologists
• Headache specialists
• Movement disorder specialists
• Sports neurology
• Neuro-infectious disease specialists

The future of Neurology:

• Expanding the knowledge of the nervous system and its treatments
• Huge number of new therapies coming out

Some pieces of advice for those thinking about entering Neurology:

• Explore both sides of Neurology - inpatient and outpatient.
• Do an elective and go to another institution to see what neurology is like there.
• Get to see as much as you can because there is a wide variety in neurology and you don't want to miss out on what you think it encapsulates just by seeing a piece of it.

Links and Other Resources:

[email protected]

Session 02 In this episode, Ryan talks with Dr. Freess, a community-based Emergency Medicine physician who shares with us why he likes Emergency Medicine and how you can become a competitive applicant. He also talks about the benefits of being an EM doctor and why he would still have chosen to become an Emergency Medicine doctor if he ever had to do it all again.

Here are the highlights of the conversation with Dr. Freess: His path to Emergency Medicine: Initially wanting Pediatrics and realizing after shadowing that he wanted Emergency Medicine

Why he chose Emergency Medicine: Fast-paced atmosphere

Down-to-earth people

Variety (everyday being completely different)

Meeting people and learning about them

Can introverts be good EM physicians? Yes, a little different but you can create a bond with the patient probably in a different way.

Working in a community hospital vs. academic hospital: There is a teaching aspect in the academic setting but there are more patients, more processes, residents, etc.

In a community setting, you can fine tune things and it allows you to have more time to patients.

Find what's best for you.

A typical day for Dr. Reess: Flexibility in shifts: Morning shifts begin at 7am

Afternoon shifts start at 5 pm

Overnight shifts start at 10 or 11 pm

Sign into the computer and see who to see next

There is no predictable day

As you move up the leadership ladder, you get to pick better shifts.

What is it to be a shift worker? There are set time periods where you're scheduled to be there.

There is not call for the most part once you're off the clock.

Does shifting have negative effects on health? There are health detriments when you change your shift around a lot but there are ways that you can work around it so it works best for you.

There are ways to avoid burnout.

There are ways to diversify your career especially when you get older and it gets tougher to switch shifts (ex. part time, administration, free clinic, etc.)

Traits that lead to being a good EM doctor: Flexibility

Making quick connection with patients

Being okay with not having long term connection with patients

How to be a competitive applicant for EM: Well-rounded in medical training and medical interest

Accepting to change

Up for a challenge

Someone with different life experiences since it goes along with being able to make connections with people

Main drivers for competitive matching in EM? Desire for shift work and working less hours than other specialties

Having good work-life balance

What residency was like for Dr. Reess: Strong work-life balance and family-oriented

Residency is a little half of your typical day since you need to do rotations in every specialty to get a sense of how they operate and get the basic knowledge

What he wished he knew going into EM: Majority of your day is dealing with "not exciting" things

95% of your patients are the routine stuff and 5% of your patients are the exciting stuff

What he wished primary care providers knew about EM: EM doctors are there to stabilize emergencies.

What he wished hospitalists knew about EM doctors: What resources EM doctors have

Unique opportunities outside of clinical care for EM physicians: Hospital administrators

Chief Information Officers / Chief Medical Officer

Pharmaceuticals

Consulting

Community Medical Board

What he likes most about being an EM physician: His everyday job and great work-life balance

"Stop and go" lifestyle

What he likes least about being an EM doctor: Shift work in nights and weekends

Inconvenient times and unpredictable schedule

The future of Emergency Medicine: More observation medicine

More community help

Generalized health system where they become the "brokers" of healthcare and the center of medical care

Some pieces of advice for those interested in EM: Try it out and try in different settings. Find diverse rotations and...

Session 02

In this episode, Ryan talks with Dr. Freess, a community-based Emergency Medicine physician who shares with us why he likes Emergency Medicine and how you can become a competitive applicant. He also talks about the benefits of being an EM doctor and why he would still have chosen to become an Emergency Medicine doctor if he ever had to do it all again.

Here are the highlights of the conversation with Dr. Freess: His path to Emergency Medicine:

Initially wanting Pediatrics and realizing after shadowing that he wanted Emergency Medicine

Why he chose Emergency Medicine:

• Fast-paced atmosphere
• Down-to-earth people
• Variety (everyday being completely different)
• Meeting people and learning about them

Can introverts be good EM physicians?

Yes, a little different but you can create a bond with the patient probably in a different way.

Working in a community hospital vs. academic hospital:

• There is a teaching aspect in the academic setting but there are more patients, more processes, residents, etc.
• In a community setting, you can fine tune things and it allows you to have more time to patients.
• Find what's best for you.

A typical day for Dr. Reess:

• Flexibility in shifts:
  • Morning shifts begin at 7am
  • Afternoon shifts start at 5 pm
  • Overnight shifts start at 10 or 11 pm
  
  
• Sign into the computer and see who to see next
• There is no predictable day
• As you move up the leadership ladder, you get to pick better shifts.

What is it to be a shift worker?

• There are set time periods where you're scheduled to be there.
• There is not call for the most part once you're off the clock.

Does shifting have negative effects on health?

• There are health detriments when you change your shift around a lot but there are ways that you can work around it so it works best for you.
• There are ways to avoid burnout.
• There are ways to diversify your career especially when you get older and it gets tougher to switch shifts (ex. part time, administration, free clinic, etc.)

Traits that lead to being a good EM doctor:

• Flexibility
• Making quick connection with patients
• Being okay with not having long term connection with patients

How to be a competitive applicant for EM:

• Well-rounded in medical training and medical interest
• Accepting to change
• Up for a challenge
• Someone with different life experiences since it goes along with being able to make connections with people

Main drivers for competitive matching in EM?

• Desire for shift work and working less hours than other specialties
• Having good work-life balance

What residency was like for Dr. Reess:

• Strong work-life balance and family-oriented
• Residency is a little half of your typical day since you need to do rotations in every specialty to get a sense of how they operate and get the basic knowledge

What he wished he knew going into EM:

• Majority of your day is dealing with "not exciting" things
• 95% of your patients are the routine stuff and 5% of your patients are the exciting stuff

What he wished primary care providers knew about EM:

EM doctors are there to stabilize emergencies.

What he wished hospitalists knew about EM doctors:

What resources EM doctors have

Unique opportunities outside of clinical care for EM physicians:

• Hospital administrators
• Chief Information Officers / Chief Medical Officer
• Pharmaceuticals
• Consulting
• Community Medical Board

What he likes most about being an EM physician:

• His everyday job and great work-life balance
• "Stop and go" lifestyle

What he likes least about being an EM doctor:

• Shift work in nights and weekends
• Inconvenient times and unpredictable schedule

The future of Emergency Medicine:

• More observation medicine
• More community help
• Generalized health system where they become the "brokers" of healthcare and the center of medical care

Some pieces of advice for those interested in EM:

Try it out and try in different settings. Find diverse rotations and trauma centers. Do a community medicine rotation abroad. Do diverse experiences and understand what EM is outside of the major trauma center.

Links and Other Resources:

www.mededmedia.com

Session 01 Welcome to the first episode of the Specialist Stories podcast, sharing with you stories of specialists from every field to give you the information you need to make sure you make the most informed decision possible when it comes to choosing your specialty.

This podcast is hosted by Dr. Ryan Gray where he will interview different physicians from various specialties to help medical students and premedical students get different perspectives on what led them to their career path. The Specialist Stories podcast is part of the MedEd Media Network where you will find all of our other shows.

In this week's episode, Ryan talks with Dr. Michelle Hure, a dermatopathologist who has her own solo practice in her community.

A brief look into Ryan's background:

Ryan went to medical school wanting to be an orthopedic surgeon and he came out of medical school (through an HPSP scholarship from the Air Force) knowing that orthopedic surgery was right for him. Unfortunately the Air Force had different plans for him. So he ultimately did not practice orthopedics and went on as a flight surgeon.

Here are the highlights of the conversation with Dr. Hure: When Michelle knew she wanted to be a dermatologist: From an interest in trauma surgery to dermatopathology

Realizing the need for work-life balance

Coming to a point of not wanting to do until her 4th years during rotation

What she likes about her specialty: Changing people's lives and curing cancer

Getting to do surgery

Being able to get home at 5

Making use of her brain everyday

What a dermatopathologist does: Two routes:

Dermatology residency

Pathology residency

As a pathologist, it involves diagnosing conditions or interpreting biopsies that is key to a patient's treatment plan. You are the doctor's doctor

Can do both clinical and pathology

A day in the life of Michelle: Reading slides of biopsies she has taken personally or those from other doctors

Seeing patients at 10 am

Traits that lead to being a good dermatopathologist: Open mindedness: Being able to think of different possibilities and looking at slides without any biases

Knowledge of clinical history and clinical medicine

Curiosity

Openness to different differential diagnosis

A lot of thinking and investigation

What makes a competitive applicant to dermatology and dermatopathology: Dermatopathology is very tough to get into since there aren't many programs so programs available are highly competitive.

Be always in your game. Walk the extra mile.

Do rotations in a place you're really interested in doing your residency as well as your fellowships.

Be willing to take initiative.

What residency was like for her: Collaboration as an important piece

Pick a residency at the particular institution where that fellowship is to have a higher chance of getting in.

What she wished she knew going into dermatology/dermatopathology: It's possible to have a family early on.

Family comes first, residency and fellowship come second

What she wished primary care providers knew more about dermatopathology: Training in dermatology and pathology

What Michelle likes most about being a dermatopathologist: Intellectual stimulation

Patient interaction

Surgery

Being able to cure cancer

What she likes the least about her practice: Dealing with insurance companies

If she had to do it all over again, would she choose another specialty? No, not at all.

What is the future of dermatopathology? The pressure of being more noticeable to people so that biopsies must be done by experts in the field and not just "general" pathologists - It's not about money, it's about patient care!

The saturation of the field

Some pieces of advice to those wanting to be a dermatopathologist: Look for work-life balance. You have to be happy with the specialty you pick. In dermatology or pathology, you will do well money-wise, but you're also going to have a good work-life...

Session 01

Welcome to the first episode of the Specialist Stories podcast, sharing with you stories of specialists from every field to give you the information you need to make sure you make the most informed decision possible when it comes to choosing your specialty.

This podcast is hosted by Dr. Ryan Gray where he will interview different physicians from various specialties to help medical students and premedical students get different perspectives on what led them to their career path. The Specialist Stories podcast is part of the MedEd Media Network where you will find all of our other shows.

In this week's episode, Ryan talks with Dr. Michelle Hure, a dermatopathologist who has her own solo practice in her community.

A brief look into Ryan's background:

Ryan went to medical school wanting to be an orthopedic surgeon and he came out of medical school (through an HPSP scholarship from the Air Force) knowing that orthopedic surgery was right for him. Unfortunately the Air Force had different plans for him. So he ultimately did not practice orthopedics and went on as a flight surgeon.

Here are the highlights of the conversation with Dr. Hure: When Michelle knew she wanted to be a dermatologist:

• From an interest in trauma surgery to dermatopathology
• Realizing the need for work-life balance
• Coming to a point of not wanting to do until her 4th years during rotation

What she likes about her specialty:

• Changing people's lives and curing cancer
• Getting to do surgery
• Being able to get home at 5
• Making use of her brain everyday

What a dermatopathologist does:

Two routes:

1. Dermatology residency
2. Pathology residency

• As a pathologist, it involves diagnosing conditions or interpreting biopsies that is key to a patient's treatment plan. You are the doctor's doctor
• Can do both clinical and pathology

A day in the life of Michelle:

• Reading slides of biopsies she has taken personally or those from other doctors
• Seeing patients at 10 am

Traits that lead to being a good dermatopathologist:

• Open mindedness: Being able to think of different possibilities and looking at slides without any biases
• Knowledge of clinical history and clinical medicine
• Curiosity
• Openness to different differential diagnosis
• A lot of thinking and investigation

What makes a competitive applicant to dermatology and dermatopathology:

• Dermatopathology is very tough to get into since there aren't many programs so programs available are highly competitive.
• Be always in your game. Walk the extra mile.
• Do rotations in a place you're really interested in doing your residency as well as your fellowships.
• Be willing to take initiative.

What residency was like for her:

• Collaboration as an important piece
• Pick a residency at the particular institution where that fellowship is to have a higher chance of getting in.

What she wished she knew going into dermatology/dermatopathology:

• It's possible to have a family early on.
• Family comes first, residency and fellowship come second

What she wished primary care providers knew more about dermatopathology:

Training in dermatology and pathology

What Michelle likes most about being a dermatopathologist:

• Intellectual stimulation
• Patient interaction
• Surgery
• Being able to cure cancer

What she likes the least about her practice:

Dealing with insurance companies

If she had to do it all over again, would she choose another specialty?

No, not at all.

What is the future of dermatopathology?

• The pressure of being more noticeable to people so that biopsies must be done by experts in the field and not just "general" pathologists - It's not about money, it's about patient care!
• The saturation of the field

Some pieces of advice to those wanting to be a dermatopathologist:

Look for work-life balance. You have to be happy with the specialty you pick. In dermatology or pathology, you will do well money-wise, but you're also going to have a good work-life balance, which is one of the most important things you need to consider in going to a particular field. Pick a specialty that you're going to do well in and you're going to be happy with.

Links and Other Resources:

www.mededmedia.com

Email Ryan at [email protected]

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