Monday, April 8, 2013

Intern Year and the R.O.A.D to Happiness.....

      Many of my non-medical friends and family are very confused as to why I am doing my intern year in surgery if I am going to be an anesthesiologist. The fact is, I am not exactly sure why, except that it is a requirement. All of the ROAD specialties + neurology are required to do their intern year in a different specialty than the one that they will eventually practice. I wish I could shed some more light on the subject, but couldn't find the precise reason even after some extensive research. My guess is that the ACGME (basically the medical regulating body) feels that the people in these specialties need a more well-rounded foundation because their ultimate specialties are so narrow and specific in scope.
      Another thing that people have been asking me when I explain that all of the ROAD specialties + neurology are required to do this intern year is......what is a ROAD specialty? A quote taken from an article from US News and World Report detailing the realities of medicine in the 21st century states that: “The R.O.A.D. to happiness lies in radiology, ophthalmology, anesthesiology, and dermatology.” Historically (and believe me, things have changed), these specialties allowed physicians to have a more controlled life than their peers in other specialties. There were fewer emergencies for these specialties in the middle of the night, and these specialties also paid far more than family or internal medicine. Essentially, and stereotypically, I might add, these were the key factors of a happy life. For many, the money is important, because most medical students graduate with an astronomical amount of debt in the form of student loans. The other thing to realize is that there is an opportunity cost associated with being pre-med and attending medical school. I graduated college almost 6 years ago and have obtained 2 graduate degrees in that time, but I have not made a dime. Many of my fellow classmates from college  have been making money since the moment they graduated. I am in my late 20's and about to get my first official paycheck (babysitting during high school does not count). Given that fact, I would love to make an adequate living that reflects the time and effort I have put into all of these years of extra schooling.
      The ROAD specialties are also more attractive to women than surgery, for example, because they are more conducive to having a family. According to a fantastic book I just finished called "Match Day," by Brian Eule, which eloquently explains the bizarre process of matching medical students with residency programs, the allure of these specialties do not go unnoticed, and applications to ROAD specialties have steadily risen for the past 10 years. The book goes on the say that some people are now tacking an E onto the end of the ROAD mnemonic, for emergency medicine, because its tendency towards shift work makes it particularly desirable. I totally agree with this notion, as a large percentage of my class, including 2 of my closest friends all applied for emergency medicine this year. Last year, there were zero unmatched positions left over in emergency medicine after the match. That says a lot, especially since I was told that there was a plastic surgery spot open (probably THE most competitive specialty of all time). On one of my anesthesia rotations, I was paired with a medical student from Columbia, who told me that the previous year 4 Columbia students failed to match into an emergency medicine residency. FROM COLUMBIA. She also said that these students had great grades, applied to enough programs, and people at the school were simply at a loss as to why it happened. It was just one of those things. The book also points out that recent articles show that medical students now place lifestyle and personal factors as being very important, where as, medical students in the 1980's had reported that those two factors had the least bearing on their specialty decision. The articles also showed that women were no more responsible for this attitude shift than men (before you try to blame women for bringing down the profession).
      I wish this ROAD stereotype still held true, but medicine has, and will continue to change drastically in the next few years. According to the author of Medical School Hell, another online blog, "...I wanted to mention...Anesthesiology. I’ve always heard the work hours and free time is great. Some of the most up-to-date data we have says otherwise. Anesthesiologists are actually working on-par with surgeons." I don't necessarily think that is 100% true, but the anesthesiologists I know work EXTREMELY hard. I also think at this point, it depends on how much money one wants to make. For now, they have the luxury to pick and choose the type of environment they wish to be in. Anesthesiologists who make the big bucks tend to work in private practices and have very long hours as well as frequent 24 calls. Academic anesthesiologists make less money but work far fewer hours, so it evens things out. It is all about personal preference. Unfortunately, or fortunately, however you view things, I believe there is no ROAD to happiness in medicine, because medicine in general is on the ROAD to the unknown. Nobody knows what is going to happen to any specialty in the next few years. All we can hope for the best.


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