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Lauren R

Pros and cons of different specialties

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Hi everyone!

I would like to write an article about the pros and cons of various specialties to help other PAs decide what specialties they might enjoy. Obviously, I haven't worked in every field so I am doing some research and asking specialists. I was wondering if any of you could help me too, by telling me your specialty and/or previous specialty and some pros and cons!

Thank you!

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I like family practice for multiple reasons.

 

First, it is never boring with a lot of variety.  I take care of people from newborns up to age 101, usually in the same day.  I get to know them and their families, often across multiple generations.  There is work in the clinic, hospital, nursing home.  Even occasional, but rare, house calls.

 

I reject those who call FP "easy."  I don't get to focus on one area of medicine, I have to know them all.  In a typical day I deal with issues involving cards, ortho, gen surgery, ob/gyn, urology, anethesiology, urology, nephrology, endocrinilogy, dermatology...

 

I do surgical procedures in the office including suturing, biopsies, skin cancer excisions, and more.  I cast simple fractures that don't need ortho.  I inject joints.  I do sideline coverage for local high school and football teams.  

 

I have my own panel of patients.  My SP/CP is there when I need him, but otherwise expects me to take care of my own business.  I am held to the same standard of care as any doc.

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Heme malignancy/blood and marrow transplantation:

 

Pros- wonderful patient population (mostly), tends to attract really caring providers and nurses, no call/nights, very complex patients to keep you on your toes

 

Cons- some weekends and holidays, emotionally hard because many patients don't do well, very complex patients to keep you on your toes (depends on the day whether I find this to be a pro or a con lol!)

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Another ER input:

 

Pros: ability to make as much as a primary care doc, fast paced, lots of procedures, ability to work with many different providers (so it's a great learning experience)

 

Cons: extremely demanding trying to keep your head above water all day, nights/weekends/holidays and usually no schedule consistency, not getting to see continuity of care so it's hard to know if what you did was good

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There is a saying that family physicians are the last "true" doctors...and the same applies to PAs.

 

I think by some (sub-specialists) we are seen as the dumbest of all specialties, but that's ignorant.

 

Like was mentioned above, we see all ages; the sick and the injured. We can cast, set fractures, excise lesions, suture, inject joints, remove a nail, treat minor injuries, infectious diseases, do physicals for all ages and manage chronic conditions. You really get to be a jack of all trades, and you never know what you're gonna get. FM is usually the first point of contact for most of society.

 

That said, I think medicine can be draining no matter where you are. The cons of FM are that you often end up as a dumping ground for stuff no one else wants to deal with. "Just go see your PCP". So you get problems that are totally unmanaged dumped in your lap, and guess what, now it's your problem. Kind of like EM, but they can boot non-urgent stuff to FM, much like we can boot the really acute stuff back to EM.

 

Also there is relentless pressure to see more patients in less time....but that's not unique to FM.

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Urgent care

 

Pros: money is great with bonuses too. I like three 12 hour shift but often they are longer. But only three days a week. Wide variety- anything can walk through the door. Several procedures usually sutures, I&Ds.

 

Cons: unless you're in a large practice you're generally the only provider (SP available by phone only). Wide variety is also a con bc I've had pts with "I think I'm having a stroke" come in and anything in between. The days can be long 12-14 hour days with no set lunch or breaks. Pt expectations that urgent care means "fast" care. No sorry there are ten people ahead of you.

 

OB/GYN

 

Pros: great pt population. Most are generally healthy with minor problems. Most of their complaints can be taken care of nothing that "you have to live with." I really love the follow up. Getting to know women on a personal and medical level. Most docs are great to work with very kind and compassionate.

 

Cons: pay is ok. It can get monotonous since it's similar for many pts, which isn't always a bad thing. Sometimes bad things and death happen to fetuses and infants.

 

 

Sent from my iPhone using Tapatalk

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Thank you so much for sharing!  All of you have given me really great material.  I'll let you guys know when the post is up.  If anyone else wants to chime in, please do share!

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If acute care, procedures and being more comfortable with the sickest patients is a professional goal consider critical care. There are few critical care PAs (approximately 1%) but the experience and knowledge obtained can open a lot of doors in your career (it's much easier to move down in patient acuity than work up in acuity). Pay for critical care is typically in the top 5 specialties.

Most hospitals are small community hospitals (large academic hospitals will have housestaff and your scope of practice will be smaller) have one intensivists and either a PA or NP. Schedule can vary but usually will be 12-13 hours for 3 shifts a week and include night and weekends generally (though both of my ICU positions are day only). The PA will round with the intensivist and manage these complex multi-organ failure patients (you will learn and recall a lot of physiology from PA school; if you are new it will require a lot of self-learning). Scope of practice is wide especially at night with the intensivist likely at home; the PA will run codes, respond to RRT, intubate, place central lines, chest tubes, taps (LP, thora, para) and a-lines. Hold family meetings, discussing goals of care and perform palliative extubations.

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Urgent Care (did this for 4 years)

Pros - can make a lot of money.  variety of cases.  12 shifts/month, which allows a fair amount of time off. 

Cons - Can be high stress - lots of "move the meat" mentality.  Pts upset about wait times.  Got to be on your toes - cannot miss the MI that presents as jaw pain or heartburn. weekends.

 

Internal medicine (2 years worth)

Pros - sick people, complex cases - very cerebral medicine.  I do most of the procedures for our IM group.  variety of opportunities - inpatient, SNF, outpatient.  good hours.  continuity of care.

Cons - call, occasionally.  lower salary.  pain medication management.  psych management.

 

Wound care (2.5 years part time)

Pros - weird stuff comes in.  being able to get things healed that other people believed would never heal. good pay.  lots of procedures.  no call, no weekends. 

Cons - outliers - people who don't heal but still hope you can work a miracle.  noncompliant patients.  hard cases with bad news. 

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I agree with LKPAC. I work in a rural FM clinic, solo coverage, doc comes 8 hrs/month, vast patient population (cradle to grave), I see all diseases you can think of plus some, that is why I LOVE FM. I do all the same procedures as listed above plus I do PFTs, allergy testing/injections, DEXA, laser treatment for BCC/Squamous, myopulse, foley (suprapubic) changes, cryotherapy, I&D, in house U/S, POC with full lab services, nerve blocks (PVNB C, T, L, S), trigger points, and I know the list goes on. Again, this is why I LOVE FM, we do it all and I believe FM is one of the hardest specialties due to the vast patient population.  

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Neurology here - 

 

Pros: Great if you like problem solving/puzzles, really interesting cases. In our clinic I don't take call or work weekends, just normal office hours, which is nice. 

 

Cons: Most things we treat are chronic diseases that likely won't go away, lots of psych and pain management

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Psych:

 

Pros: get to know patients, smaller inventory of meds to prescribe, no call/weekends/holidays (outpatient psych office), great pay, appointment only (no walk in), still do labs and have continued exposure to general medicine as patients have surgeries, DM, HTN, COPD, etc that come along with the depression.  I just don't have to manage of those conditions, but still talk about them and educate about them.  

 

Cons: getting to know some patients, no stethoscope, no hands on physical exam (not that I love touching patients, but not ausc H/L and palpating an abd every day seems odd since I did ER/IM/Acute care most of my career), paperwork! PAs/RFAs/TARs, work slips, disability, etc....lots of people asking to be "disabled" because that's easier then working (certainly some actually are disabled).  Psych meds are never one size fits all (except benzo's of course because everyone wants them) it is more challenging finding the right combination of meds for many patients.  Getting patients to do their part of the treatment plan and not just thinking the meds will fix everything.  

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Cardiology.

 

Pros - lots of hospital work, very interesting patients, specialty field but still exposed to all of medicine on an inpatient basis, some critical care, some very complex patients.  I had regular hours and only had to work about one weekend per month.  Cardiology is also about the broadest specialty because cardiovascular disease is so common.  Lots of interaction with the emergency room if doing inpatient work.  Cardiology is an optimistic field, in that many patients can be treated--with stents, bypass surgery, valve surgery, pacemaker, ICD, heart transplant, or with medical therapy for heart failure or angina, etc.  Can also stent kidneys, legs, treat hypertension for aortic dissection, evaluate for thrombus in stroke patient, control heart rate in AFIB, ablate arrhythmias.  Lots of diagnostic modalities available.  Cardiac meds are pretty broad.  Endocarditis is infectious disease.  Cancer patients also have heart problems, like pericardial effusion. Unlike in primary care, don't have to have quite as broad an expertise. 

 

Cons - Hospital work has its own unique frustrations...like not having your own office and having to interact with the staff of 20 different hospital units, including the ER.  Patients (not all) can be very complex.  Sometimes you have to communicate via interpreter.  By the time you see the patient, he or she has already been evaluated by PCP or ER doctor, and possibly the admitting physician and several other consultants.  So in that sense, you may be doing less truly diagnostic work than in primary care.   Also you may be sent to do a consult on a patient who is down in PET scan or having PT or being seen by another consultant...so have to bounce back later to do your consult.  You may walk into a room with a dozen family members present...and have to ask all but one to leave while you evaluate the patient.  Still lots of pressure to see more patients...and often with life-threatening and complex conditions.  Less independence from MD in hospital work due to the critical nature of the illnesses.

 

In cardiology, it helps to be calm by temperament and easy to get along with because of all of the above. 

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Urgent Care:

 

Pros: Broad scope (you never know what is coming from open fractures to CVA's to ACS to sepsis), fast/focused visits, high pay, no call, and you can always send patient to higher level of care (ED).

 

Cons: High stress (see: broad scope and fast/focused above), sometimes inadequate support staff (only MA's in many cases), and closing time rush of patients which usually includes a laceration repair and chest pain/shortness of breath at the same time.

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On 9/28/2016 at 1:41 PM, jb5158 said:

Neurology here - 

 

Pros: Great if you like problem solving/puzzles, really interesting cases. In our clinic I don't take call or work weekends, just normal office hours, which is nice. 

 

Cons: Most things we treat are chronic diseases that likely won't go away, lots of psych and pain management

What about the time constraints in terms of how long they give you to do all the write ups and paperwork for each patient? Would you say that you are pressured to see lots of patients quickly or is neurology a field where you actually have more time to think things through without getting mentally strained and being under pressure constantly? 

I’m wondering what specialties in Medicine are not very fast paced, don’t include life-threatening emergencies or decisions that have to be made on the spot, ones that you’re not pressured to see as many patients as possible quickly. Essentially not slow paced but also not fast paced like ER. I hear sleep medicine is pretty good but as a PA you don’t get to do as many interesting cases is that right?

 

Edited by NathanSaruriPA87

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Abdominal Transplant (Inpatient)

Pros: interesting, complex, opportunity to get to know patients well, passionate multidisciplinary team, rewarding

Cons: schedule (rotating days nights weekends holidays), the occasional bad outcome

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Addiction Medicine 

 

pros : great hours, no call , no weekends , no procedures (to some that may be a con) , adequate time for each visit , patients stay engaged months to years so you really get to know them and their families , super rewarding to see people in recovery 

cons: it can be heartbreaking to see your patients relapse ,  Suboxone scripts with your DEA # are at huge risk of diversion , patients lie A LOT 

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