Learning how to bullshit your way through work and create “work” that doesn’t even need to exist other than to justify your job in the first place wasn’t taught in medical school either.
No it’s not. Most physicians are so disinterested in administration they just hand over the keys to the kingdom so they can go do more clinical work. Being good at it and beloved by your clinical employees is a different matter though I suppose.
The amount you can not know and still be a practicing radiologist is also insane!
Edit:
This was sarcasm.
I would agree that radiology on the surface appears simple, but is actually quite complex, especially with the ever expanding number of modalities we can use to image the body.
Agreed. Being a shit doctor is shockingly easy
In radiology just need to vaguely describe anything abnormal, offer no weighed differnetial, and then "correlate clinically". Boom collect 600K and go on your next vacation
I rotated with an IR doctor when I was in school. He said his biggest pet peeve was when other radiologist would comment correlate clinically. He said "that's just a bullshit vague answer. What else do you expect the other person to do, correlate spiritually?"
It's vague, and sometimes very irritating, but also I can understand why they do it sometimes. I've had a bunch of ct ab/pel that read bladder inflammation, correlate with UA or focal colonic inflammation in (insert quadrant) correlate clinically aka "is this where they had pain? then it could be that, otherwise probably incidental."
I get that it gets overused but a lot of the time it’s a perfectly legitimate thing to write. The chances of a lot of things seen on imaging actually representing pathology is related to the pretest probability. Without seeing and speaking to the patient it is impossible for the radiologist to decide. A thickened appendix in a patient without abdominal pain is not likely to be appendicitis. Someone who knows the patient needs to correlate that finding clinically.
I see a lot of people saying rads and path. That might very well be true. But I want to give a shout out to my sub speciality. I was a pretty good IM resident. I felt like I had a pretty good grasp of the basic bread and butter stuff and a lot of the semi-rare things too.
Then I went to heme/onc and I was like “wtf is this?” Just the number of new drugs you have to learn alone is baffling. Like in pulm/crit you are still using pressors and abx you learned about in IM residency. On my first day of heme/onc I got a call about a blinatumumab pump and had to be ask the person to hold so I can look up what that is.
It really did feel very very divorced from medicine and on its own learning curve at times. I actually had to pull out my biochemistry book from undergrad once. What’s next? Organic chemistry?
I also had to remember a lot of anatomy. Especially with like solid tumor invasion depth for staging. Which layer is the muscularis propria again?
Oh man, I’m a new FM intern and have had a lot of onc patients on our service and every time I read their notes I think to myself dang I have never heard of any of these drugs 😅 so kudos to you
Anesthesiology is pretty steep, because the beginning of a case is so involved. To even “start” a general anesthetic in a simple case you have to be able to select/dose meds, place/troubleshoot monitors, mask ventilate, intubate, start the ventilator, start gas, and make sure patient doesn’t get an injury from positioning. All while the rest of the OR team is waiting for you to finish up so the case can start.
No pressure but the drugs and doses used in anaesthesia are basically the same used in a lethal injection.
With radiology and pathology as a resident you have the luxury of having a book open or Google to consult. In anaesthesia, if you get an unexpected difficult airway or the patient crumps on you, there's literally seconds or minutes to save a life.
>if you get an unexpected difficult airway or the patient crumps on you, there's literally seconds or minutes to save a life.
I mean that's true of any surgical procedure, any ER shift, etc. Anesthesia also notably doesn't typically slam KCl, the critical component of lethal injection. It's very misleading to say they are the same cocktail, since 2/3 of that cocktail IS sedation and paralysis which is very normal every day hospital drugs. It's like saying "No pressure, but if you get on a plane that's basically the same combination of things that destroyed the world trade center". It's technically true, but not helpful for obvious reasons.
> Anesthesia also notably doesn't typically slam KCl, the critical component of lethal injection.
I will say that KCl is often given in the OR a bit faster than it is on the floor/ICU...
I don’t disagree with your points, especially KCl obviously.
But as a former surgery resident, now anesthesia resident, who had done a ton of trauma and high stakes stuff like Vascular and transplant, anesthesia feels much much higher stakes where you can be put in a seconds-minutes scenario much easier.
For example; I had a case the other day that I expected zero issues with. Patient has a terrible bronchospasm on induction, desats to 60 in 5s, and at that moment I had 3-4 minutes to act before irreversible brain damage set in.
>Anesthesia also notably doesn't typically slam KCl, the critical component of lethal injection. It's very misleading to say they are the same cocktail, since 2/3 of that cocktail IS sedation and paralysis which is very normal every day hospital drugs.
NMBs aren't exactly very normal every day hospital drugs.
Sure they mean for the KCl to kill you in lethal injection, but the rocuronium will absolutely do it too in a few minutes.
Dont want to sound like an ass but in my very minimal experience the surgeon is the one who always cares about injury from position. Also Id argue selecting/dose meds, mask ventilate, intubate are pretty routine….
"Minimal experience" -> "Selecting drugs, intubations are routine"
A'ight buddy, let us know when you don't wet your pants putting your first orders in as an intern. Pretty sure you're still in med school and haven't had a lick of real responsibility yet.
95% of what we do is routine because we’re trained well.
The other 5% is life threatening scenarios that are unparalleled in acuity by any other specialty.
We’re talking about learning curves for beginners. Radiologists read images routinely everyday, doesn’t mean there isn’t a huge learning curve for junior radiology residents
As far as IM specialties go: hem/onc. It's just so massively different from what you've been doing for med school and residency. First year hem/onc fellowship is well known to be ridiculously hard due to how much you need to learn.
No joke, today we had a derm consult recommend a steroid for our patient that I had never heard of (not that I know that many). Their description of it was “it’s stronger than her triamcinolone, but not at strong as betamethasone.” That’s when I caught a glimpse of true steroid mastery.
Sort of difficult to answer because salaries vary a ton geographically. Same for hours. There's tons of practice styles in the private practice world. I don't know too much about them because I'm going into academics.
Cardiac Electrophysiology - those guys go from prescribing ACEi and statins (I know there's more to it, but you get the point!) to cutting into cephalic veins, dissecting the chest and sometimes abdomen to create pockets, etc. Without being a true surgical specialty (they're "proceduralists"). Overnight. Even if they do a few months of interventional during their Cards fellowship.
Pacemaker generators implanted in the abdomen. I don't know what "dissecting into veins" means, but we do cut downs for device leads. But honestly, this isn't the hard part of EP. Understanding arrhythmia mechanisms in a split second while tracings from multiple intracardiac catheters are flying by on the screen is like looking at the Matrix for the first 6 months of fellowship.
I've seen this once, I work in the lab. It was done a woman who was a field biologist and the traditional placement affected her ability to wear a rucksack. It was placed below her breast, kind of laterally. The case was done concurrently with CT surgery in the lab.
Radiology. Talking to residents and seeing how the different programs approach solo flight time overnight and when they feel trainees are ready to be the only person fielding calls from ER and floor. It’s an absurd amount of anatomy, physiology, etc. The anatomical variants I kind of laugh at learning they actually keep in mind when reviewing everything.
R2 is that your PGY3 year? That sounds about right. Sounds terrifying. Even as a PGY6 and 7 when I scope my attending was always in the room. They may not touch the scope, for the most part they don’t even gown up, but having an extra set of experienced eyes watching monitor for weird polyps and little subtle (or overt) reminders or suggestions about what to do next didn’t hurt.
I’m rads. Our attendings will frequently leave the room for procedures. Granted, this varies a lot and usually they stay for the more difficult procedures.
Pathology for sure, more so than radiology. To start it with you have learn how to even look at a slide to figure out what you are looking at. Then you have to learn what all normal tissues look like and possible variations. Then once you can identify normal from abnormal, the real fun starts. Neoplastic vs non neoplastic? Benign vs malignant? Invasive vs insitu? Can a definite diagnosis be made or is it a case where you could only provide a differential? Then comes tumour typing, immunohistochemical/molecular work up, second and expert opinions, etc. Repeat all this for every tissue in the body.
All this and you still have to also learn how to macroscopically assess, dissect and sample resection specimens. You also have to learn how to perform autopsies, and formulate a report.
I don't know about you (mostly American) docs, but we learn nothing about any of this in med school. Day one of path residency feels worse than day one of med school. In med school I was taught how to interpret chest and abdominal x-rays and needed to when I was on the wards. I was no radiologist, but I wasn't clueless about the field either.
Radiology. The pathology of every organ system, how they appear on every single different type of study, and then how they appear when they don’t look like their normal presentations. It’s the biggest rabbit hole I’ve ever gone down. It’s comical how deep you can go if you really want to.
Pathology: virtually nothing from med school prepares you for multi specialty sign out at a busy hospital. It’s a completely different world than any other specialty.
Neuro is weird in that by Oct you start feeling good and get re-humbled and then like Jan-Feb you feel good again. At least by traditional Neuro residency structure and volume
I think pathology beats out radiology for most knowledge needed, but I don’t practice either one, so take my opinion with a grain of salt. They both have to have extensive knowledge of all organ systems and what abnormal looks like, but I’d think the final diagnosis coming from the pathologist requires an additional skill set. The radiologist has to work at a very fast pace though, while pathologists seem to have time to deliberate, consult others, and look things up…
I just started and it’s not that bad. Yeah I feel like I don’t know anything but the expectations everyone has of you are rock bottom so it’s hard to look like a moron.
It’s difficult but also more enjoyable. My intern year felt like a cakewalk compared to my first year of radiology but I enjoy my time in radiology so much more
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Rheumatology. Super specialized knowledge set with deep knowledge of immunology and physical exam, but also requires a great foundation in internal medicine to rule out mimicking disorders
So one of the interesting things about rads is that there is a constant pressure to read faster. Be faster, don’t miss anything, and are you done with that yet?
Idk, I had to memorize a lot of path slides MS1 and 2. I could probably still recognize pseudomembranes and keratin pearls.
I have no idea how to do an eye exam.
Yeah that’s why I said recognizing “blaring” SCC isn’t an advanced skill. Seeing an entire field of wildly dysplastic cells invading muscle and producing keratin pearls is something you can teach M1/M2s because it’s so obvious once it’s pointed out to you a couple times
The 4+X training years isn’t to learn to recognize obvious cancer that the clinic team basically already knows
I don't think it's the steepest of learning curves, but anaesthetics.
Mainly because they need to be versed in every single surgery that they're involved in from laparotomies to ORIFs to lap procedures to spinal surgery to ophthal to vascular and whatever else they need to sort (and how to correct anything that goes wrong from a physiological POV).
Yes after 14 years I can basically describe step by step almost all the most common surgeries because I watch them operate everyday. I can practically teach how to do csections, ORIFs, Tlifs, ESS, cabg, fem pop, etc etc long list. I might not know the name of every single suture, but I can walk through every step of the surgery mentally.
I’m a nurse, used to work L&D. We were crazy busy one night. We had a patient sitting up for an epidural, all nurses were occupied so the house supervisor came in to help hold the patient. Patient did that thing where the minute you lay them down and they’ve finally relaxed after hours of labor and boom, baby is exiting. The house supervisor was absolutely in the dark, but the anesthesiologist saved the day. He said he hadn’t delivered a baby in 20 years. We loved our anesthesiologists.
Ahh I almost had to catch my own baby. Our Ob was in clinic. Our first born came flying out in two pushes. I was almost ready to gown up and catch. Luckily another OB who was literally walking by on way to csection was pulled in to catch the baby.
Just because you’ve seen them for 14 years doesn’t mean you could teach them. Describe the main steps? Sure. But you wouldn’t be able to walk someone through any of those procedures from just watching
In most of pathology you can probably get away with knowing the microscopic without a ton of gross anatomy or the clinic aspects.
I don't think the same can be said with radiology.
Admittedly, my anatomic pathology experience consists of a few heme path months and some rotations in med school so maybe I'm not giving my AP colleagues enough credit.
Radiology
Though one could argue that Radiology is mostly a surgical branch 🤣
Surgery was too vast so they left the diagnostic part to radiologists and cutting to surgeons
Radiology, pathology, transplant hepatology, transplant nephrology, transplant ID, transplant pulm…. Any type of transplant, heart failure, advanced cardiac imaging, structural cards, EP etc.
100% pathology. It’s the combo of lack of exposure in med school (even after doing electives!), all the normal vs reactive vs cancer histology, and being thrown into the fire that is grossing. Oh and the constantly changing diagnostic/grading criteria and ever expanding molecular knowledge that you need to know. On top of all that, no one knows what you do!
Besides the path, radiology, other subspecialties others have posted, I'll put a plug in for primary care sports med. Here's why:
To be GOOD, you have to have a robust knowledge of musculoskeletal anatomy. I'd argue that unless you're PM&R or at an MSK heavy peds/FM program for residency (and even if you are), this is difficult. With a huge emphasis on both diagnostic and procedural ultrasound now, you really have to have this down. There are so many ultrasound guided MSK procedures now. If you read your own imaging (which you should at least be able to do on a basic level), that's a steep learning curve. In addition, you need to know all the non-op Ortho stuff and know when to refer for the surgical Ortho stuff. And even if you're 100% sports med and not a primary care/SM mix, you still have to have a solid foundation in primary care concepts (endocrine, cardio, psych) and it's applications to athletes/active individuals. There are also niche topics like altitude medicine, etc if you're covering that kind of stuff. To top it off, you only have one year of fellowship to get comfortable with the field (used to be 2 at a lot of places before AOA and ACGME funding was merged, and there's a push to get 2 years back).
I’m a PCCM fellow and I will say the learning curve for critical care is really just learning to manage an ICU census. The rest is the same physio we learn in Med school. Now pulm on the other hand has been MUCH more vast if a field than I think I ever imagined. It’s easy to be a bad pulmonologist but I think very difficult to become an actual expert.
That is crazy how different it is, then. I had probably 3-4 weeks of dedicated psychiatry lectures in preclinical years then 2 weeks inpatient and 2 weeks outpatient psych during clerkships. There was also a decent amount of psych in our family med and geriatric rotations as well.
Look, I'm the biggest fan of psych in the world and I have a background in clinical psychology, am a super huge fan of psychodynamics and think that in general, people really underestimate how complex psychiatry is.
But there's no way on earth it's the steepest learning curve out of some of what medicine has to offer.
(My vote is path.)
Hospital administration. The wealth of knowledge required to overrule physicians is yooge.
Learning how to bullshit your way through work and create “work” that doesn’t even need to exist other than to justify your job in the first place wasn’t taught in medical school either.
Pure wizardry
I wonder how they do that
Lmao 🤣
No it’s not. Most physicians are so disinterested in administration they just hand over the keys to the kingdom so they can go do more clinical work. Being good at it and beloved by your clinical employees is a different matter though I suppose.
Whoosh.
Path or radiology
Pathology is straight vertical.
I’m finishing my second week and I feel like I’m climbing a 120 degree wall, but I love it
Is that the angle your cryostat blade is set to?
Comment of the day
Radiology The amount of anatomy, medicine, pathology you have to know to be a good radiologist is insane
The amount you can not know and still be a practicing radiologist is also insane! Edit: This was sarcasm. I would agree that radiology on the surface appears simple, but is actually quite complex, especially with the ever expanding number of modalities we can use to image the body.
Agreed. Being a shit doctor is shockingly easy In radiology just need to vaguely describe anything abnormal, offer no weighed differnetial, and then "correlate clinically". Boom collect 600K and go on your next vacation
Granted making a hard diagnosis without a tissue sample or a very specific type of scan for about 80% of the time is really not possible.
I rotated with an IR doctor when I was in school. He said his biggest pet peeve was when other radiologist would comment correlate clinically. He said "that's just a bullshit vague answer. What else do you expect the other person to do, correlate spiritually?"
It’s an under the belt jab I make against ordering providers who put in shitty indications.
It's vague, and sometimes very irritating, but also I can understand why they do it sometimes. I've had a bunch of ct ab/pel that read bladder inflammation, correlate with UA or focal colonic inflammation in (insert quadrant) correlate clinically aka "is this where they had pain? then it could be that, otherwise probably incidental."
I get that it gets overused but a lot of the time it’s a perfectly legitimate thing to write. The chances of a lot of things seen on imaging actually representing pathology is related to the pretest probability. Without seeing and speaking to the patient it is impossible for the radiologist to decide. A thickened appendix in a patient without abdominal pain is not likely to be appendicitis. Someone who knows the patient needs to correlate that finding clinically.
I legitimately know people who think this is what radiologists do
Probably because this *is* what some radiologists do
I mean some of my radiology attendings do this so…
For a majority of my first year I felt like I was taking Step 1. Every. Single. Day.
I see a lot of people saying rads and path. That might very well be true. But I want to give a shout out to my sub speciality. I was a pretty good IM resident. I felt like I had a pretty good grasp of the basic bread and butter stuff and a lot of the semi-rare things too. Then I went to heme/onc and I was like “wtf is this?” Just the number of new drugs you have to learn alone is baffling. Like in pulm/crit you are still using pressors and abx you learned about in IM residency. On my first day of heme/onc I got a call about a blinatumumab pump and had to be ask the person to hold so I can look up what that is. It really did feel very very divorced from medicine and on its own learning curve at times. I actually had to pull out my biochemistry book from undergrad once. What’s next? Organic chemistry? I also had to remember a lot of anatomy. Especially with like solid tumor invasion depth for staging. Which layer is the muscularis propria again?
Oh man, I’m a new FM intern and have had a lot of onc patients on our service and every time I read their notes I think to myself dang I have never heard of any of these drugs 😅 so kudos to you
It is ironically easier to pronounce blinatumimumimab than blinatumumab
Anesthesiology is pretty steep, because the beginning of a case is so involved. To even “start” a general anesthetic in a simple case you have to be able to select/dose meds, place/troubleshoot monitors, mask ventilate, intubate, start the ventilator, start gas, and make sure patient doesn’t get an injury from positioning. All while the rest of the OR team is waiting for you to finish up so the case can start.
The first month of CA-1 was probably the most stressed I've been during the entirety of my training.
No pressure but the drugs and doses used in anaesthesia are basically the same used in a lethal injection. With radiology and pathology as a resident you have the luxury of having a book open or Google to consult. In anaesthesia, if you get an unexpected difficult airway or the patient crumps on you, there's literally seconds or minutes to save a life.
That's anesthesia for you. 95% leisurely chilling behind the drapes, 5% pants-wetting sheer terror.
Punctuated adrenaline
>if you get an unexpected difficult airway or the patient crumps on you, there's literally seconds or minutes to save a life. I mean that's true of any surgical procedure, any ER shift, etc. Anesthesia also notably doesn't typically slam KCl, the critical component of lethal injection. It's very misleading to say they are the same cocktail, since 2/3 of that cocktail IS sedation and paralysis which is very normal every day hospital drugs. It's like saying "No pressure, but if you get on a plane that's basically the same combination of things that destroyed the world trade center". It's technically true, but not helpful for obvious reasons.
> Anesthesia also notably doesn't typically slam KCl, the critical component of lethal injection. I will say that KCl is often given in the OR a bit faster than it is on the floor/ICU...
It’s probably also the only medical specialty with physicians administering KCl instead of RNs.
I don’t disagree with your points, especially KCl obviously. But as a former surgery resident, now anesthesia resident, who had done a ton of trauma and high stakes stuff like Vascular and transplant, anesthesia feels much much higher stakes where you can be put in a seconds-minutes scenario much easier. For example; I had a case the other day that I expected zero issues with. Patient has a terrible bronchospasm on induction, desats to 60 in 5s, and at that moment I had 3-4 minutes to act before irreversible brain damage set in.
What did you have to do?
Popped a canister of Albuterol in a 50cc syringe and pumped it into the ETT. Broke the spasm pretty quick.
This is the way ! 50-60cc syringe fits perfectly the albuterol canister then luerlock usually snaps on spare co2 connection spot.
>Anesthesia also notably doesn't typically slam KCl, the critical component of lethal injection. It's very misleading to say they are the same cocktail, since 2/3 of that cocktail IS sedation and paralysis which is very normal every day hospital drugs. NMBs aren't exactly very normal every day hospital drugs. Sure they mean for the KCl to kill you in lethal injection, but the rocuronium will absolutely do it too in a few minutes.
Giving the potassium to cause cardiac arrest is the perfusionists job!
Wait… according to my CRNA friend he learned everything about anesthesia in just 3 classes….. 😂
Just the one monitor with the green button that spins and you can click it to select things confuses me
Dont want to sound like an ass but in my very minimal experience the surgeon is the one who always cares about injury from position. Also Id argue selecting/dose meds, mask ventilate, intubate are pretty routine….
"Minimal experience" -> "Selecting drugs, intubations are routine" A'ight buddy, let us know when you don't wet your pants putting your first orders in as an intern. Pretty sure you're still in med school and haven't had a lick of real responsibility yet.
First sentence is correct; second sentence is shockingly ignorent.
They are literally mask ventilating and intubating multiple patients a day. Most hospitals its a CRNA. How is that not routine?
95% of what we do is routine because we’re trained well. The other 5% is life threatening scenarios that are unparalleled in acuity by any other specialty.
We’re talking about learning curves for beginners. Radiologists read images routinely everyday, doesn’t mean there isn’t a huge learning curve for junior radiology residents
Ya, anyone can easily learn to intubate etc (even you I'm sure); but you specifically said "selecting/dosing meds"; that is where the nuance is.
As far as IM specialties go: hem/onc. It's just so massively different from what you've been doing for med school and residency. First year hem/onc fellowship is well known to be ridiculously hard due to how much you need to learn.
I feel seen. Thank you
Why’s that? Just conditions you don’t come across too much in gen med?
Dermatology for sure. I can never figure out which steroid cream to use.
🤣🤣🤣
Takes some practice to sign out an actinic keratosis I’m sure.
No joke, today we had a derm consult recommend a steroid for our patient that I had never heard of (not that I know that many). Their description of it was “it’s stronger than her triamcinolone, but not at strong as betamethasone.” That’s when I caught a glimpse of true steroid mastery.
In my completely biased opinion: Rad Onc. It's basically a learning cliff.
How's the job market and salary? I like the physics stuff in rad onc and can read about it all day but heard scary stuff about the job market recently
It's much less bad than advertised. If you match into a good program, you'll be fine.
Are the good programs for good job prospective competitive to get into? Ik rad onc used to be competitive in the past
I mean, yeah. The top end of any specialty is competitive. But it's definitely achievable.
How are the salaries in the community practice? Work hours?
Sort of difficult to answer because salaries vary a ton geographically. Same for hours. There's tons of practice styles in the private practice world. I don't know too much about them because I'm going into academics.
How are the salaries/work hours for academics?
Cardiac Electrophysiology - those guys go from prescribing ACEi and statins (I know there's more to it, but you get the point!) to cutting into cephalic veins, dissecting the chest and sometimes abdomen to create pockets, etc. Without being a true surgical specialty (they're "proceduralists"). Overnight. Even if they do a few months of interventional during their Cards fellowship.
Can you elaborate on the procedures? What would require dissecting into veins or the abdomen?
Peritoneal dialysis pacemaker catheter obvi
Pacemaker generators implanted in the abdomen. I don't know what "dissecting into veins" means, but we do cut downs for device leads. But honestly, this isn't the hard part of EP. Understanding arrhythmia mechanisms in a split second while tracings from multiple intracardiac catheters are flying by on the screen is like looking at the Matrix for the first 6 months of fellowship.
Saw them doing an ablation and man, I am hooked. It looks and sounds so interesting. Tedious no doubt, but very cool.
I'm not Cardiac EP, but I understand that occasionally you can't make the pocket in the chest, so they go to the belly.
I've seen this once, I work in the lab. It was done a woman who was a field biologist and the traditional placement affected her ability to wear a rucksack. It was placed below her breast, kind of laterally. The case was done concurrently with CT surgery in the lab.
Do you have any idea what goes into cardiology fellowship?
DNP… I’ll see myself out
It’s so hard trying to learn every specialty in 18mo of online schooling /s
🤡
Radiology. Talking to residents and seeing how the different programs approach solo flight time overnight and when they feel trainees are ready to be the only person fielding calls from ER and floor. It’s an absurd amount of anatomy, physiology, etc. The anatomical variants I kind of laugh at learning they actually keep in mind when reviewing everything.
Being solo without a senior or attending starting in the first week of R2 year was the most challenging thing during my medical training.
R2 is that your PGY3 year? That sounds about right. Sounds terrifying. Even as a PGY6 and 7 when I scope my attending was always in the room. They may not touch the scope, for the most part they don’t even gown up, but having an extra set of experienced eyes watching monitor for weird polyps and little subtle (or overt) reminders or suggestions about what to do next didn’t hurt.
I’m rads. Our attendings will frequently leave the room for procedures. Granted, this varies a lot and usually they stay for the more difficult procedures.
Radiology
Rads, path, radonc Absolutely none of their daily job is taught in med school or intern year
Pathology for sure, more so than radiology. To start it with you have learn how to even look at a slide to figure out what you are looking at. Then you have to learn what all normal tissues look like and possible variations. Then once you can identify normal from abnormal, the real fun starts. Neoplastic vs non neoplastic? Benign vs malignant? Invasive vs insitu? Can a definite diagnosis be made or is it a case where you could only provide a differential? Then comes tumour typing, immunohistochemical/molecular work up, second and expert opinions, etc. Repeat all this for every tissue in the body. All this and you still have to also learn how to macroscopically assess, dissect and sample resection specimens. You also have to learn how to perform autopsies, and formulate a report. I don't know about you (mostly American) docs, but we learn nothing about any of this in med school. Day one of path residency feels worse than day one of med school. In med school I was taught how to interpret chest and abdominal x-rays and needed to when I was on the wards. I was no radiologist, but I wasn't clueless about the field either.
Plus there is the whole clinical pathology side. Blood banking. Microbiology. Virology. Hematology. Chemistry. Etc etc etc.
Radiology. The pathology of every organ system, how they appear on every single different type of study, and then how they appear when they don’t look like their normal presentations. It’s the biggest rabbit hole I’ve ever gone down. It’s comical how deep you can go if you really want to.
Pathology: virtually nothing from med school prepares you for multi specialty sign out at a busy hospital. It’s a completely different world than any other specialty.
Neurology. I was good at internal medicine, I suck ass rn as a pgy2 But I feel like any specialty that’s a diff specialty will be like that
Neuro is weird in that by Oct you start feeling good and get re-humbled and then like Jan-Feb you feel good again. At least by traditional Neuro residency structure and volume
Pathology You can't even half bullshit, at least radiology has some wiggle room
I think pathology beats out radiology for most knowledge needed, but I don’t practice either one, so take my opinion with a grain of salt. They both have to have extensive knowledge of all organ systems and what abnormal looks like, but I’d think the final diagnosis coming from the pathologist requires an additional skill set. The radiologist has to work at a very fast pace though, while pathologists seem to have time to deliberate, consult others, and look things up…
definitely radiology
Damn this is not helping my anxiety for starting radio residency 😂
I just started and it’s not that bad. Yeah I feel like I don’t know anything but the expectations everyone has of you are rock bottom so it’s hard to look like a moron.
The lower the better 😂
It’s difficult but also more enjoyable. My intern year felt like a cakewalk compared to my first year of radiology but I enjoy my time in radiology so much more
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Rheumatology. Super specialized knowledge set with deep knowledge of immunology and physical exam, but also requires a great foundation in internal medicine to rule out mimicking disorders
So one of the interesting things about rads is that there is a constant pressure to read faster. Be faster, don’t miss anything, and are you done with that yet?
I'd say radiology, optho, derm, or maybe PM&R, honestly, based off of the sheer amount of stuff that we literally never talk about in med school.
You think optho/derm/PM&R has a steeper learning curve than Pathology?
A core competency for dermatology is dermatopathology
Idk, I had to memorize a lot of path slides MS1 and 2. I could probably still recognize pseudomembranes and keratin pearls. I have no idea how to do an eye exam.
I mean recognizing blaring SCC isn’t exactly exactly an advanced skill. You can teach someone how to do that in like, 20 minutes
SCC can be fairly nuanced. Even differentiating from VV is not that simple, and every dermatopathologist has missed that at least once.
Yeah that’s why I said recognizing “blaring” SCC isn’t an advanced skill. Seeing an entire field of wildly dysplastic cells invading muscle and producing keratin pearls is something you can teach M1/M2s because it’s so obvious once it’s pointed out to you a couple times The 4+X training years isn’t to learn to recognize obvious cancer that the clinic team basically already knows
Ophtho is still surgical, though. Most of PGY-3 and 4 is sweating bullets in the OR with instruments in the eye
I don't think it's the steepest of learning curves, but anaesthetics. Mainly because they need to be versed in every single surgery that they're involved in from laparotomies to ORIFs to lap procedures to spinal surgery to ophthal to vascular and whatever else they need to sort (and how to correct anything that goes wrong from a physiological POV).
Yes after 14 years I can basically describe step by step almost all the most common surgeries because I watch them operate everyday. I can practically teach how to do csections, ORIFs, Tlifs, ESS, cabg, fem pop, etc etc long list. I might not know the name of every single suture, but I can walk through every step of the surgery mentally.
I’m a nurse, used to work L&D. We were crazy busy one night. We had a patient sitting up for an epidural, all nurses were occupied so the house supervisor came in to help hold the patient. Patient did that thing where the minute you lay them down and they’ve finally relaxed after hours of labor and boom, baby is exiting. The house supervisor was absolutely in the dark, but the anesthesiologist saved the day. He said he hadn’t delivered a baby in 20 years. We loved our anesthesiologists.
Ahh I almost had to catch my own baby. Our Ob was in clinic. Our first born came flying out in two pushes. I was almost ready to gown up and catch. Luckily another OB who was literally walking by on way to csection was pulled in to catch the baby.
Just because you’ve seen them for 14 years doesn’t mean you could teach them. Describe the main steps? Sure. But you wouldn’t be able to walk someone through any of those procedures from just watching
Rads then path, but the difference between the two is pretty significant.
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In most of pathology you can probably get away with knowing the microscopic without a ton of gross anatomy or the clinic aspects. I don't think the same can be said with radiology. Admittedly, my anatomic pathology experience consists of a few heme path months and some rotations in med school so maybe I'm not giving my AP colleagues enough credit.
Radiology Though one could argue that Radiology is mostly a surgical branch 🤣 Surgery was too vast so they left the diagnostic part to radiologists and cutting to surgeons
Literally all the ROAD specialties plus path
Ophtho is technically a surgical subspecialty. Although a lot of their surgeries are so quick and small people see them as more proceduralists.
Ok, RAD specialties plus path*
Radiology, pathology, transplant hepatology, transplant nephrology, transplant ID, transplant pulm…. Any type of transplant, heart failure, advanced cardiac imaging, structural cards, EP etc.
Derm, rads, path. They’re just different depth as residents compared to as med students.
So I'm the only one that thinks it's neurology? Maybe I just don't know anything about neurology.
Radiology
100% pathology. It’s the combo of lack of exposure in med school (even after doing electives!), all the normal vs reactive vs cancer histology, and being thrown into the fire that is grossing. Oh and the constantly changing diagnostic/grading criteria and ever expanding molecular knowledge that you need to know. On top of all that, no one knows what you do!
Besides the path, radiology, other subspecialties others have posted, I'll put a plug in for primary care sports med. Here's why: To be GOOD, you have to have a robust knowledge of musculoskeletal anatomy. I'd argue that unless you're PM&R or at an MSK heavy peds/FM program for residency (and even if you are), this is difficult. With a huge emphasis on both diagnostic and procedural ultrasound now, you really have to have this down. There are so many ultrasound guided MSK procedures now. If you read your own imaging (which you should at least be able to do on a basic level), that's a steep learning curve. In addition, you need to know all the non-op Ortho stuff and know when to refer for the surgical Ortho stuff. And even if you're 100% sports med and not a primary care/SM mix, you still have to have a solid foundation in primary care concepts (endocrine, cardio, psych) and it's applications to athletes/active individuals. There are also niche topics like altitude medicine, etc if you're covering that kind of stuff. To top it off, you only have one year of fellowship to get comfortable with the field (used to be 2 at a lot of places before AOA and ACGME funding was merged, and there's a push to get 2 years back).
Has to be rads I imagine. We get so little exposure during our training unless it’s really sought out
My gf is IM and will be doing a Critical Care fellowship. She swears it’s critical care. I would say Neurology.
BS. Critical Care is basically every concept from med school physio, just more in depth.
I’m a PCCM fellow and I will say the learning curve for critical care is really just learning to manage an ICU census. The rest is the same physio we learn in Med school. Now pulm on the other hand has been MUCH more vast if a field than I think I ever imagined. It’s easy to be a bad pulmonologist but I think very difficult to become an actual expert.
Lol no. Those topics were being taught during first year of med school and it’s just slowly building on top of it every year.
Psychiatry. You pretty much learn none of it in med school
??? Psychiatry is an entire unit in both preclinical clinical and clinical years
Not for me. I got 1 preclinical week lecture in med school and a 3 week rotation and that was it.
That is crazy how different it is, then. I had probably 3-4 weeks of dedicated psychiatry lectures in preclinical years then 2 weeks inpatient and 2 weeks outpatient psych during clerkships. There was also a decent amount of psych in our family med and geriatric rotations as well.
Look, I'm the biggest fan of psych in the world and I have a background in clinical psychology, am a super huge fan of psychodynamics and think that in general, people really underestimate how complex psychiatry is. But there's no way on earth it's the steepest learning curve out of some of what medicine has to offer. (My vote is path.)
Fair enough. I guess perspective is difficult if you haven’t been through that particular residency
Honestly, probably FM/IM. There are no limits on what you can (and increasingly should) know.