HMS Specialty Interest Series

04 Oct 2018 » James Diao » Boston, MA

Overview

The Specialty Interest Series is a biweekly career lunch seminar series that brings a diverse group of clinicians from affiliated hospitals to HMS to discuss different specialty areas. All main specialties (over 19 altogether) are represented.

Since I’m quite undecided about which area I want to specialize in, I thought it’d be great to hear more about all the different available areas from people who actually work in them now. The following is a sorted collection of paraphrased quotes that I thought were interesting or useful.

Contents

  1. Radiation Oncology
  2. Neurology
  3. Orthopedic Surgery
  4. Radiology
  5. Ophthalmology
  6. Amusing Stereotypes

Radiation Oncology (08/23/2018)

tl;dr

HMS Match

Based on 32 applicants from the 2015-2018 match lists


Anthony D’Amico

Chief of Genitourinary Radiation Oncology at BWH, Director of Career Advising at HMS

Every specialty has its own personality. When the orthopedic surgeons come in, you’ll see: they’re very different from the dermatologists. It has do with your values. So who should go into radonc?

First and foremost, you need to be someone who derives fulfillment from being in front of someone who’s been diagnosed with cancer. They are scared to death. Their family is scared. A radiation oncologist will, through education, patience, and kindness, clearly and methodically give them the knowledge they need to get to the next step of what they can do. Radiation oncology is very personal. There will be long face-to-face conversations and family meetings. They will hang on every word you say. They will not forget anything. They are looking to you for hope. If you thrive on these situations, radonc may be for you.

Second, you need technical proficiency. Radonc is the surgical equivalent of local treatment. You have to be able to understand and plan radiation treatment based on complex 3D images from multiple sources (CT, PET, etc.).

Brandon Mahal

Fellow, Harvard Radiation Oncology Program

The job has immense variety, and all the residents and attendings are happy. I get to see my kids as much as I need. That’s not to say I don’t work hard–if you add in research, I work just as many hours as any other specialty. But I have more of a say in how I organize my day. If all else is equal, I’d advise that you go for the job that offers balance and predictability.

Fallon Chipidza

Fellow, Harvard Radiation Oncology Program

In my third year, I was mostly undifferentated, but was interested in both medical oncology and radiation oncology. I liked that radiation oncology was very team-dependent and got a lot of patient interaction. I also liked the technical aspects–contouring and physics are very cool.

There’s also a misconception that radonc is a “lifestyle specialty” where you don’t have to work very hard. That’s not true–there are days when I’ve been in the office until 9pm. It is not chill.

Jennifer Wo

Clinical Attending at MGH and Assistant Professor at HMS

If you love dealing with patients and critical moments, you should consider radiation oncology. You see most of your patients alongside surgeons and medoncs, and you hear all the surgical and chemo questions and learn all the differences and subtleties.

The lifestyle also allows work-life balance. I knew I wanted a family. I was married and thinking of children, and found the chance to pursue this. I ended up having 3 kids in 6 years; my patients would come back in and ask “are you pregnant again??”

The hours go from around 8:00-9:00 to 4:30-5:30. Most of time is clinical, with academic work sandwiched into my free time. Taking 1-2 months off at a time is tough because oncology comes with longitudinal relationships and continuity of care. Sabbaticals are possible, but must be planned in advance. This model would be easier with shift work, like in emergency medicine.

Neurology (09/06/2018)

tl;dr

HMS Match

Based on 24 applicants in neurology and child neurology from the 2015-2018 match lists


David Chung

Neurology resident at MGH; Fellow in Neurocritical Care

Good neurologists are intellectually curious about the nervous system. The old adage about neurology is that all neurologists are expert diagnosticians who can’t actually do anything for their patients. This is untrue; clinical advancements allow us to make a big difference in managing and treating disease.

My schedule as a resident on the stroke service was as follows: I would arrive at 6am and start rounding from 7am-10:30am, with intermittent lectures. There’s usually a group lecture at noon with free lunch. The afternoon is then work rounds (following up on diagnostics, discharging patients, etc.) until around 5pm, when the chief resident wraps things up and you go home. On important days, junior residents stay longer.

The stroke service was very imaging-heavy, involving reads of many CT scans. The rest of my work largely involved conditions like headaches, fainting, and tremors. Nowadays, my work in neurocritical care follows a flexible 1 week on, 1-2 weeks off schedule.

Husain Danish

Third-year Resident at MGH; Pre-Fellow in Neuro-Oncology

I was attracted to neurology because there’s no other field where disease has so profoundly changed the way the patient interacts with and perceives the world. A lot of the work involves helping patients overcome disability.

People say neurology is depressing because patients don’t get better, but this is not true. The brain can recover, and our patients often look very different just a few months later.

On a day-to-day level, neurology residency involves many night shifts. Busy days mean a lot of clinical decisions; lax days mean a lot of Netflix and Youtube. My current workday goes from 7pm to 8am. When other team members arrive in the morning, I present a morning report and review new overnight admissions.

Bernard Chang

Associate Professor of Neurology at BIDMC, Advisory Dean of Peabody Society at HMS

I enjoy neurology because of the long-term relationships with patients; there are many chronic illness that are managed but not cured.

I want to point out that the experiences of this panel might not be entirely representative. The residents you’ve just heard from typically handle the sickest inpatients, but most patients are less critical outpatients (over 90% come from the ER). Similarly over 80% of neurologists are in private practice, and none of us can offer a perspective outside academia.

That being said, I can tell you more about life as an attending. My schedule involves two half-days of outpatient clinical work a week. Every year, I will also spend ten weeks in the inpatient service (typically in two week blocks). My hours are 8:30am-6:30pm, but I’ll sometimes go in as early as 6am to get work done before everyone else arrives. As for my non-clinical work days, I spend around 50% of time advising and teaching medical students and residents, and serving on administrative committees. The rest of the time, I serve as an editor for a neurology journal and review manuscripts for publication.

Orthopedic Surgery (09/20/2018)

tl;dr

HMS Match

Based on 25 applicants in orthopedic surgery from the 2015-2018 match lists


Samantha Spencer

President of the Massachusetts Orthopedic Association, Pediatric Orthopedic Surgeon and Assistant Professor at BWH

A day on the trauma service can vary a lot; I never really know what it will look like. We usually get around 10 patients overnight, and 3-5 are scheduled for surgery. This goes roughly from 7:30 in the morning to 3-7 in the evening.

Jeff Zilberfarb

Private Practice in Orthopedic Surgery and Sports Medicine at New England Baptist Hospital

My life is very scheduled. I start at 7am every morning. I’m in the OR a couple days a week and those are more variable; they can end anytime from 3-6pm. When I’m not in the OR, I’m in the office until 4-5pm.

Julie Glowacki

Professor of Orthopedic Surgery at HMS, Director of Skeletal Biology at BWH

Orthopedic surgery is challenging, but can be very rewarding. Around 80% of orthopedic surgeons came to medical school knowing they wanted to do ortho. The commitment can be daunting; I tried to get into a more relaxed field like radiology, but I’ve never needed so much coffee to stay awake. I’m a people person; I love interacting with others, and I wanted that in my specialty.

Kristin Alves

HCORP chief resident; fellowship in pediatrics and global ortho surgery, MPH,

I love orthopedic surgery because you get to play such a big part in the care and well-being of patients. People love you; if you sit down in an airplane and people find out you’re an orthopedic surgeon, everyone wants to talk to you. You get to be proud of your job. Ortho also gives you tons of operating experience; you get all the coolest cases. For example, we were on the front lines after the Boston marathon bombings. Orthopedic procedures are also usually able to deliver better outcomes than other surgical fields, like neurosurgery.

Ortho is hard, but it’s possible to strike a balance in any field of medicine. I’ve dated and traveled during residency, while doing a lot of research and volunteer work.

In terms of getting in: you don’t need all your research to be in ortho itself. I mostly did neurosurgery research during medical school before I decided on ortho. It can be basic science, clinical or whatever. You just have to be excited and knowledgeable; there’s nothing worse than showing up and not knowing what your papers are about. You also need to do well on STEP 1. Scores mostly depend on how you prepare. Get advice from friends who have done well.

Radiology (10/04/2018)

tl;dr

HMS Match

Based on 24 applicants in radiology (DR/IR) from the 2015-2018 match lists


Dominique Rowcroft

Diagnostic Radiology Resident at Mt. Auburn Hospital

You’re behind the scenes and get less credit. But you also get to see more patients and this makes a humongous impact. You just have to be okay with being behind the scenes and getting less credit credit. Radiologists are consultants to other doctors; you talk to them about the patient’s images and teach them what you’re seeing and what’s going on.

People think that we just sit in a dark room and not talk to people, but that’s not true. You have to meet patients to get consent, stick a needle, help them into the machine, etc.

My schedule starts around 7:30-8am. I read scans most of the time, with breaks for teaching and case rounds with residents. Most days, I finish by 5-6pm.

Priscilla Slanetz

Associate Professor of Radiology (Breast Imaging) and Radiology Residency Program Director at BIDMC

Radiology offers the chance to do easy global outreach. It’s very interdisciplinary and has great research opportunities; for example, some newer areas involve investigation of molecular imaging and tracers. Some worry that machine learning will take our jobs, but machine learning still can’t do procedures and can’t handle edge cases. We’re hoping it will improve the process by taking over the boring or frustrating cases.

Most radiologists add 1-2 of subspecialty training on top of 1 year of internship and 4 years of residency.

Jeffrey Weinstein

Vascular and Interventional Radiologist and Program Director of Interventional Radiology at BIDMC

I like that radiology lets me keep up with pathology and anatomy all over the body. I did have to give up some patient interaction, but IR offers more direct patient care. I also enjoy the variety of each day. We get to solve unique problems and work with high-end technology.

Liwei Jiang

Second-Year Interventional Radiology Resident at BWH

I was the first resident in the integrated program at the Brigham, so I’m the guinea pig. I chose IR because it’s tech-heavy and has a very tangible impact on patients. I’m also okay with taking a backseat and not necessarily being the face of doctor who saved your life.

Colin McCarthy

Interventional Radiology Fellow at MGH

I did 2 years of surgery before switching to IR. I really like having ownership of my own patients. For example, I got an email from a patient from more than three years ago letting me know how he’s been doing. I really appreciate this part of my career.

Ophthalmology (11/01/2018)

tl;dr

HMS Match

Based on 32 applicants from the 2015-2018 match lists


Sherleen Chen

Director of the Comprehensive Ophthalmology and Cataract Consultation Service

Most of my time is spent in outpatient patient care, not in surgery. Still, these visits are necessary for me to see enough patients to generate surgical volume; only around 6% of visits lead to cataract surgery cases. My job provides great work-life balance; I can easily ramp up or down to adjust to family or other demands. I know that my work is important; vision is so precious to patients. Ophthalmology is also one of the happiest specialties with the lowest burnout rates. 93% of practicing ophthalmologists would choose the same specialty, 2nd only to dermatology (96%).

Alice Lorch

Chief Quality Officer at MEEI

I chose ophthalmology because I enjoyed performing the physical exam and the procedures; I also liked working with lenses, understanding the structures of the eye, and the surgical aspect. Patients really value their sight and losing it is a huge deal. They are always so appreciative of the work I do.

Elizabeth Rossin

Instructor in Ophthalmology, Director of the Ocular Trauma Service

In ophthalmology, it is easy to access the organ you’re studying. Drugs and interventions can be delivered and observed directly; ophthalmic research is very translational. Ophthalmology also interfaces with many other specialties, including rheumatology, oncology, and endocrinology (usually diabetic retinopathy). We also function as “gateway diagnosticians”, because many patients will ignore their symptoms only until their vision begins to decline; we end up being the first physicians they come to.

Roberto Pineda

Associate Professor of Ophthalmology, Associate Director of Global Surgery and Health at MEEI

I come from an engineering background, so I enjoy working with all the tools and gadgets in this field. One of the reasons I was originally thinking internal medicine over specializing is that I wanted to work in global health and public health, and I thought you had to be a generalist. I’ve found that you can do this just as well in ophthalmology as a specialist. Most physicians don’t know much about the eye, and I like being a specialist and having this knowledge that other physicians consult me for.

Amusing Stereotypes

MD Specialty Stereotypes

MD Specialty Flowchart 1 MD Specialty Flowchart 2

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