Allergy/ImmunologyAmerican Board of Medical Specialties description: "An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Selected examples of such conditions include asthma, anaphylaxis, rhinitis, eczema, and adverse reactions to drugs, foods, and insect stings as well as immune deficiency diseases (both acquired and congenital), defects in host defense, and problems related to autoimmune disease, organ transplantation or malignancies of the immune system. As our understanding of the immune system develops, the scope of this specialty is widening.
Training programs are available at some medical centers to provide individuals with expertise in both allergy/immunology and adult rheumatology, or in both allergy/immunology and pediatric pulmonology. Such individuals are candidates for dual certification.
Training required: Prior certification in Internal Medicine or Pediatrics; two years in allergy/immunology.
Certification in the following subspecialty requires additional training and examination.
Clinical & Laboratory Immunology: A subspecialist who utilizes various laboratory procedures to diagnose and treat disorders characterized by defective responses of the body's immune systems. These results are used for patient management." Reproduced from Which Medical Specialist for You, ABMS. Revised, March 2000.
Other A/I information links and sources
Careers in A/I for Medical Students, an American Academy of Allergy, Asthma & Immunology web page.
Try a PubMed search using these (or your own) search strings:
allergy and immunology career allergy and immunology/trends allergy and immunology/education allergy and immunology/economics.AnesthesiologyAmerican Board of Medical Specialties description: "An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an operation, an obstetric or diagnostic procedure. The anesthesiologist assesses the risk of the patient undergoing surgery and optimizes the patient's condition prior to, during, and after surgery. In addition to these management responsibilities, the anesthesiologist provides medical management and consultation in pain management and critical care medicine. Anesthesiologists diagnose and treat acute. long-standing and cancer pain problems; diagnose and treat patients with critical illnesses or severe injuries; direct resuscitation in the care of patients with cardiac or respiratory emergencies, including the need for artificial ventilation; and supervise post-anesthesia recovery.
Training required: Four years.
Certification in one of the following subspecialties requires additional training and examination.
Critical Care Medicine: An anesthesiologist who specializes in critical care medicine diagnoses, treats and supports patients with multiple organ dysfunction. This specialist may have administrative responsibilities for intensive care units and may also facilitate and coordinate patient care among the primary physician, the critical care staff, and other specialists.
Pain Management: An anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic and/or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists." Reprinted from Which Medical Specialist for You, ABMS. Revised, March 2000.
More anesthesiology info ....
"Information about Anesthesia as a Career," the personal thoughts of Dr. John Oyston, staff anesthesiologist at Scarborough Hospital, Ontario, Canada.
American Society of Anesthesiologists web site. See the Society's related links for a long listing of other anesthesiology organizations.
American Academy of Pain Medicine web site.
Society of Critical Care Medicine web site. Start with "Professional Resources" section and then try the "Education" and "Public Affairs" areas.
Try searching PubMed using the terms "medical students specialty anesthesiology." Substituting "career choice" for "specialty" will yield a longer list that includes many of the same articles. Other fruitful search terms:
anesthesiology/trendsanesthesiology/economicsanesthesiology/educationRecent journal articles:
"The selection of a residency program: prospective anesthesiologists compared to others," Anesthesia and Analgesia, Aug. 1993, 313-7. PubMed Abstract: A study was undertaken to investigate factors important to senior medical students, particularly prospective anesthesiology residents, in selecting a residency program. A previously published questionnaire was used to determine whether previous findings could be replicated. One hundred ninety-seven senior medical students rated the importance of 22 items in their selection of a residency program. Factors were ranked nearly identically as in the previous study. Factors rated as most important were "diversity of training experience" as well as "house officer satisfaction," whereas items about treating patients with the acquired immunodeficiency syndrome were rated as least important. There were gender differences that showed women assigned more importance to having a manageable case load, call schedules, and geographic location. Prospective anesthesiology residents perceived "prestige" of the program, and the department as significantly more important than did prospective nonanesthesiology residents. The replication of results with regard to the overall ranking of factors demonstrates the reliability of the results. Resident selection committees need to focus on the issue of quality of training, the impression made by the interviewers, and include satisfied residents as part of the interview process.
"Specialty intentions of 1995 U.S. medical school graduates and patterns of generalist career choice and decision making," Academic Medicine, Dec. 1995, pp 1152-7. PubMed Abstract: The authors report on the specialty intentions that graduating students declared on the 1995 AAMC Medical School Graduation Questionnaire (GQ) and compare the pattern of career choices in 1995 with that in 1992. Family practice was the leading choice of graduates in 1995, followed by internal medicine subspecialties and general internal medicine. These choices represented significant gains over those made in these specialties in 1992 and were at the expense of declines in the interest of 1995 graduates for internal medicine specialties, radiology, anesthesiology, obstetrics-gynecology subspecialties, and some other fields. In 1992, 14.6% of graduating students declared plans to pursue careers in one of the generalist specialties; in 1995, 27.6% declared such plans. In 1992, no school graduated 50% or more students with generalist intentions, and only one school reached 40%; in 1995, five schools graduated more than 50%, and another 15 graduated more than 40% who favored generalist careers. Medical schools with significant GQ response rates (110 out of 125) were aggregated by level of generalist production (top 25%, middle 50%, and bottom 25%) according to the percentages of their 1995 graduates selecting careers in the individual generalist specialties of family practice, general internal medicine, and general pediatrics, and in these generalist specialties in toto. Within these groups, the linking of GQ responses to declarations given by the same students on the Matriculating Student Questionnaire (MSQ) made it possible to determine the extent to which graduates' specialty choices represented early interests that were retained or interests acquired later during medical school.
"Factors affecting the choice of anesthesiology by medical students for specialty training," Journal of Medical Education, Apr. 1984, 323-30. PubMed Abstract: To learn some of the reasons why anesthesiology as a specialty is not preferred by more graduating medical students and to determine the effects of various factors on their specialty choice, the authors studied the number of medical students who chose anesthesiology as a specialty after graduation and the quality of clerkships available in various departments. The study established that medical students do not find anesthesiology as attractive as other specialties and that several factors are related to the students' choice of anesthesiology. Most surprising was the negative effect of the presence of certified registered nurse anesthetists on the operating room floor. These results suggest the need for a thorough study of the use of nurse practitioners, physician's assistants, and nurse-clinicians, at least where teaching of medical students is taking place.
DermatologyAmerican Board of Medical Specialties description: "A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles, and other tumors of the skin, the management of contact dermatitis, and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars, and the skin changes associated with aging.
Training required: Four years.
Certification in one of the following subspecialties requires additional training and examination.
Clinical and Laboratory Dermatological Immunology: A dermatologist who utilizes various specialized laboratory procedures to diagnose disorders characterized by defective responses of the body's immune system. Immunodermatologists also may provide consultation in the management of these disorders and administer specialized forms of therapy for these diseases.
Dermatopathology:A dermatopathologist has the expertise to diagnose and monitor diseases of the skin including infectious, immunologic, degenerative, and neoplastic diseases. This entails the examination and interpretation of specially prepared tissue sections, cellular scrapings, and smears of skin lesions by means of routine and special (electron and fluorescent) microscopes." Reprinted from Which Medical Specialist for You, ABMS. Revised, March 2000.
More dermatology info ....
Try searching PubMed using the terms "medical students specialty dermatology." Substituting "career choice" for "specialty" will yield a slightly different list. Other fruitful search terms:
dermatology/trendsdermatology/economicsdermatology/educationEmergency MedicineAmerican Board of Medical Specialties description: "An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury:
Training required: Three years.
Certification in one of the following subspecialties requires additional training and examination.
Medical Toxicology: An emergency physician who has special knowledge about the evaluation and management of patients with accidental or purposeful poisoning through exposure to prescription and nonprescription medications, drugs of abuse, household or industrial toxins, and environmental toxins. Areas of medical toxicology include acute pediatric and adult drug ingestion, drug abuse, addiction and withdrawal; chemical poisoning exposure and toxicity; hazardous materials exposure and toxicity; and occupational toxicology.
Pediatric Toxicology:An emergency physician who has special qualifications to manage emergencies in infants and children.
Sports Medicine: An emergency physician with special knowledge in sports medicine is responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention and management of injury and illness. A sports medicine physician has knowledge and experience in the promotion of wellness and the role of exercise in promoting a healthy lifestyle. Knowledge of exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation and epidemiology is essential to the practice of sports medicine." Reprinted from Which Medical Specialist for You, ABMS. Revised, March 2000.
Other emergency medicine information links and sources:
Society for Academic Emergency Medicine's "Emergency Medicine as a Career Choice."
Try searching PubMed using the terms "medical students specialty emergency medicine." Substituting "career choice" for "specialty" will yield a slightly different list. Other fruitful search terms:
emergency medicine/trendsemergency medicine/economicsFamily PracticeAmerican Board of Medical Specialties description: "A family physician is concerned with the total health care of the individual and the family, and is trained to diagnose and treat a wide variety of ailments in patients of all ages. The family physician receives a broad range of training that includes internal medicine, pediatrics, obstetrics and gynecology, psychiatry, and geriatrics. Special emphasis is placed on prevention and the primary care of entire families, utilizing consultations and community resources when appropriate.
Training required: Three years.
Certification in one of the following subspecialties requires additional training and examination.
Geriatric Medicine: A family physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive, and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital.
Sports Medicine: A family practice physician who is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice), and the role of exercise in promoting a healthy life style are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as a individual or in team participation." Reprinted from Which Medical Specialist for You, ABMS. Revised, March 2000.
Other family practice information links and sources:
American Academy of Family Physicians web site, including "Family Practice--What You Need to Know," which has video profiles of practicing family physicians.
To see a more extensive and current list of articles on this topic, do a search in PubMed using the terms "medical students specialty family practice." Substituting "career choice" for "specialty" will yield a slightly different hit list. Also, try:
family practice/trendsfamily practice/economicsfamily practice/education"Prime Time," The New Physician, April 2000, pp 10-17. Summary: A week in the life of Dr. Michele A. Romano, who has a solo family practice in northern Virginia.
GeriatricsAlso see Family Practice and Internal Medicine sections.
Other geriatrics information links and sources:
To see a more extensive and current list of articles on this topic, search in PubMed using the term strings:
medical students career choice geriatricsgeriatrics/trendsgeriatrics/economicsgeriatrics/education."Help wanted: geriatricians," The New Physician, Jan.-Feb 2001, pp 32-42. Summary: Needs of a growing elderly population in the United States require more geriatricians, experts say. The American Geriatrics Society says only 8,000 geriatricians currently practice, but the aging population could support 16,000 more. One reason for the small number of practioners is the median income of geriatricians: about $141,500, lowest of medical specialties, reports the Medical Group Management Association. Low Medicare reimbursement rates also deter potential geriatricians, although one expert says that these rates are looking more attractive as managed care pushes reimbursement rates down for other populations. Experts say geriatrics knowledge is important to each specialty but medical schools generally fall short in providing it.
Links
Internal MedicineAmerican Board of Medical Specialties description: "A personal physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults, and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections, and diseases affecting the heart, blood, kidneys, joints, and digestive, respiratory and vascular systems. They are also trained in the essential of primary care internal medicine which incorporates an understanding of disease prevention, wellness, substance abuse, mental health, and effective treatment of common problems of the eyes, ears, skin, nervous system, and reproductive organs.
Training required: Three years.
Certification in one of the following subspecialties requires additional training and examination.
Adolescent medicine: An internist who specializes in adolescent medicine is a multi-disciplinary health care specialist trained in the unique physical, psychological, and social characteristics of adolescents, their health care problems and needs.
Cardiovascular Disease: An internist who specializes in diseases of the heart, lungs, and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythmns.
Clinical Cardiac Electrophysiology: A field of special interest within the subspecialty of cardiovascular disease which involves intricate technical procedures to evaluate heart rhythms and determine appropriate treatment for them.
Clinical and Laboratory Immunology: An internist who uses laboratory tests and complex procedures to diagnose and treat disorders characterized by defective responses of the body's immune system.
Critical Care Medicine: An internist who diagnoses, treats and supports patients with multiple organ dysfunction. This specialist may have administrative responsibilities for intensive care units and may also facilitate and coordinate patient care among the primary physician, the critical care staff, and other specialties.
Endocrinology, Diabetes and Metabolism: An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, pituitary diseases, and menstrual and sexual problems.
Gastroenterology: An internist who specializes in diagnosis and treatment of diseases of the digestive organs, including the stomach, bowels, liver, and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer, and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to see internal organs.
Geriatric Medicine: An internist with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive, and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital.
Hematology: An internist with additional training who specializes in diseases of the blood, spleen, and lymph glands. This specialist treats conditions such as anemia, clotting disorders, sickle cell disease, hemophilia, leukemia, and lymphoma.
Infectious Disease: An internist who deals with infectious diseases of all types and in all organs. Conditions requiring selective use of antibiotics call for this special skill. This physician often diagnoses and treats AIDS patients and patients with fevers which have not been explained. Infectious disease specialists may also have expertise in preventive medicine and conditions associated with travel.
Interventional Cardiology: An area of medicine within the subspecialty of cardiology which uses specialized imaging and other diagnostic techniques to evaluate blood flow and pressure in the coronary arteries and chambers of the heart and technical procedures and medications to treat abnormalities that impair the function of the heart.
Medical Oncology: An internist who specializes in the diagnosis and treatment of all types of cancer and other benign and malignant tumors. This specialist decides on and administers chemotherapy for malignancy, as well as consulting with surgeons and radiotherapists on other treatments for cancer.
Nephrology: An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation.
Pulmonary Disease: An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational diseases, bronchitis, sleep disorders, emphysema, and other complex disorders of the lungs.
Rheumatology: An internist who treats diseases of joints, muscle, bones, and tendons. This specialist diagnoses and treats arthritis, back pain, muscle strains, common athletic injuries, and 'collagen' diseases.
Sports Medicine: An internist trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice), and the role of exercise in promoting a healthy life style are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as a individual or in team participation." Reprinted from Which Medical Specialist for You, ABMS. Revised, March 2000.
Other internal medicine information links and sources:
American College of Physicians-American Society of Internal Medicine (ACP-ASIM) Internal Medicine Careers page.
To see a more extensive and current list of articles on this topic, search in PubMed using the term strings:
medical students career choice internal medicine
internal medicine/trends
internal medicine/economics
internal medicine/education
Recent articles
"The effect of medical education on primary care orientation: results of two national surveys of students' and residents' perspectives," Academic Medicine, Apr. 2001, pp 355-65. PubMed Abstract: To examine changes among a nationally representative sample of students and residents in their orientations toward primary care as reflected in their attitudes toward the psychosocial and technical aspects of medicine and their perceptions of the academic environment for primary care. METHOD: Confidential telephone interviews of stratified national probability samples of first- and fourth-year medical students and residents were conducted in 1994 and 1997. The 1997 survey included 219 students and 241 residents who had also been interviewed in 1994. Participants were asked about their attitudes toward addressing psychosocial issues in medicine and their perceptions of faculty and peer attitudes toward primary care. Responses were compared over time and across groups. RESULTS: Between the first and fourth years of medical school, there was a decline over time in students' reported orientations to socioemotional aspects of patient care (61.6% versus 42.7%, p =.001) and their perceptions that working with psychosocial issues of patients made primary care more attractive (56.3% versus 43.5%, p =.01). This pattern continued for 1997 residents (PGY-3), who were even less likely to say that addressing psychosocial issues made primary care more attractive (26.9%). For fourth-year students in 1994 who became PGY-3 residents in 1997, there was an increased perception that non-primary-care house officers and specialty faculty had positive attitudes toward primary care (20.8% versus 33.0%, p =.005; 28.3% versus 45.7%, p <.0001; respectively). CONCLUSIONS: Between 1994 and 1997 students and residents perceived a positive shift in the attitudes of peers and faculty toward primary care. During the course of their education and training, however, the students experienced an erosion of their orientations to primary care as they progressed through medical school into residency.
"Specialty choices of students who actually have choices: the influence of excellent clinical teachers," Academic Medicine, Mar. 2000, pp 278-82.
PURPOSE: To determine the influence of the quality of attending physicians and residents on the specialty choices of excellent medical students, who actually have a broad choice of specialties. METHOD: In 1993-94 and 1994-95, 169 third-year students at the University of Kentucky College of Medicine were randomly assigned to two one-month rotations on general medicine inpatient wards. At the end of each rotation, the students confidentially evaluated the attending physician and the supervising resident (different for each rotation) with whom they had worked. Data were collected for 62 attending physicians and 89 residents. The authors analyzed the influences of the "best" and "worst" clinical instructors (those rated in the top and the bottom 20% by all students with whom they had worked over the two years) on "excellent" medical students (the 52 students whose USMLE I scores were in the top 30% of their class). RESULTS: Using regression approaches from the general linear model, the authors found that independent predictors of internal medicine residency choice for excellent medical students were exposure to highly rated internal medicine attendings (p = .02) and residents (p = .03). Nine of 29 (30%) of the excellent students who worked with a "best" medicine clinical instructor chose an internal medicine residency, while none of the 23 excellent medical students who did not work with a "best" medicine clinical instructor did so. The authors found no correlation in students' ratings of their pairs of attendings and residents, suggesting that rater bias did not explain the results. CONCLUSION: Better medical students who work with the best internal medicine attending physicians and residents in their internal medicine clerkship are more likely to choose an internal medicine residency.
"Motivation underlying career choice for internal medicine and surgery," Social Science and Medicine, Dec. 1997, pp 1705-13. PubMed Abstract: Self-determination theory (Deci and Ryan, 1985) was used to predict medical students' career choices for internal medicine or surgery based on their experiences of the autonomy support provided by the instructors in the two corresponding third-year clerkships. Fourth-year medical students (n = 210) at three medical schools completed questionnaires that assessed (1) retrospective prior likelihood (as of the end of second year) of their going into internal medicine and surgery, (2) their perceived competence with respect to these two medical specialties, (3) their interest in the problems treated in each specialty, (4) the autonomy support of the instructors on the two corresponding rotations, (5) the current likelihood (late in the fourth year) of going into each of the two specialties, and (6) their actual residency choices. For a subset (n = 64), actual prior likelihoods of going into the two careers had also been assessed at the end of their second year. Structural equation modeling confirmed, as hypothesized, (a) that perceived autonomy support of the corresponding clerkship would predict students' choices of internal medicine or surgery, even after the effects of retrospective (and actual) prior likelihood had been removed, and (b) that this relationship between perceived autonomy support and career choice was mediated by perceived competence and interest. The present study suggests that students' experiences on clerkships do affect the likelihood that they will select particular specialties, and that students' interest in the areas are good indicators of the selections they will make.
Medical GeneticsAmerican Board of Medical Specialties description: "A specialist trained in diagnostic and therapeutic procedures for patients with genetically linked diseases. This specialist uses modern cytogenic, radiologic, and biochemical testing to assist in specialized genetic counseling, implements needed therapeutic interventions, and provides prevention through prenatal diagnosis. A medical geneticist plans and coordinates large-scale screening programs for inborn errors of metabolism, hemoglobinopathies, chromosome abnormalities, and neural tube defects.
Training required: Two or four years.
The Board issues multiple general certificates in the following areas of genetics:
Clinical Biochemical Genetics: A clinical biochemical geneticist demonstrates competence in performing and interpreting biochemical analyses relevant to the diagnosis and management of human genetic diseases, and is a consultant regarding laboratory diagnosis of a broad range of inherited disorders.
Clinical Cytogenetics: A clinical cytogeneticist demonstrates competence in providing laboratory diagnostic and clinical interpretive services dealing with cellular components, particularly chromosomes, associated with heredity.
Clinical Genetics (M.D.): A clinical geneticist demonstrates competence in providing comprehensive diagnostic, management, and counseling services for genetic disorders.
Clinical Molecular Genetics: A clinical molecular geneticist demonstrates competence in performing and interpreting molecular analyses relevant to the diagnosis and management of human genetic diseases, and is a consultant regarding laboratory diagnosis of a broad range of inherited disorders.
Ph.D. Medical Genetics: A medical geneticist works in association with a medical specialist, is affiliated with a clinical genetics program, and serves as a consultant to medical and dental specialists.
Certification in the following subspecialty requires one year additional training and examination:
Molecular Genetic Pathology: A molecular genetic pathologist is expert in the principles, theory, and technologies of molecular biology and molecular genetics. This expertise is used to make or confirm diagnoses of Mendelian genetic disorders, of human development, infectious diseases and malignancies, and to assess the natural history of those disorders. A molecular genetic pathologist provides information about gene structure, function, and alteration and applies laboratory techniques for diagnosis, treatment, and prognosis for individuals with related disorders." Reprinted from Which Medical Specialist for You, ABMS. Revised, March 2000.
More info....
Careers in the Genetics Field, by the Federation of American Societies for Experimental Biology.
To see a more extensive and current list of articles on this topic, do a search in PubMed using the terms
Neurology/Child NeurologyAmerican Board of Medical Specialties description: "A neurologist specializes in the diagnosis and treatment of all types of disease or impaired function of the brain, spinal cord, peripheral nerves, muscles, and autonomic nervous system, as well as the blood vessels that relate to those structures. A child neurologist has special skills in the diagnosis and management of neurologic disorders of the neonatal period, infancy, early childhood and adolescence.
Training required: Four years.
Certification in one of the following subspecialties requires additional training and examination.
Clinical Neurophysiology: A neurologist who specializes in the diagnosis and management of central, peripheral, and autonomic nervous system disorders using a combination of clinical evaluation and electrophysiologic testing such as electroencephalography (EEG), electromyography (EMG), and nerve conduction studies (NCS), among others.
Neurodevelopmental Disabilities: A pediatrician or neurologist who specializes in the diagnosis and management of chronic conditions that affect the developing and mature nervous system, such as cerebral palsy, mental retardation, and chronic behavioral syndromes, or neurologic conditions.
Pain Management: A neurologist or child neurologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings." Reprinted from Which Medical Specialist for You, ABMS. Revised, March 2000.
Other neurology/child neurology information links and sources:
American Academy of Neurology has a Medical Student Information section. Look under "Education and CME" in the site index.
To see an extensive and current list of articles on this topic, do a search in PubMed using the terms "medical students specialty neurology." Substituting "career choice" for "specialty" will yield a slightly longer list, including many of the same articles.
"Controllable lifestyle: a new factor in career choice by medical students,"
Academic Medicine, Oct. 1989, pp 606-609. PubMed abstract: To determine whether control of work hours (controllable lifestyle) was becoming an increasingly important factor in choices of specialties by medical students, data from three medical schools over the past ten, ten, and six years, respectively, were reviewed for the types of specialty training entered by students in the top 15% of their classes. Since students in the upper 15% of the class are likely to obtain the specialties of their choice, any change in the pattern of their specialty preferences probably reflects a general trend. Specialties that feature a controllable lifestyle (CL) were defined as anesthesiology, dermatology, emergency medicine, neurology, ophthalmology, otolaryngology, pathology, psychiatry, and radiology. Non-CL specialties were surgery, medicine, family practice, pediatrics, and obstetrics-gynecology. The results showed that the percentages of students entering CL specialties increased significantly at all three schools, the percentages of students entering non-CL specialties decreased significantly at all three schools, and there was no significant change in the percentage of students entering surgical specialties.
Nuclear MedicineAmerican Board of Medical Specialties description: "A nuclear medicine specialist employs the properties of radioactive atoms and molecules in the diagnosis and treatment of disease, and in research. Radiation detection and imaging instrument systems are used to detect disease as it changes the function and metabolism of normal cells, tissues, and organs. A wide variety of diseases can be found in this way, usually before the structure of the organ involved by the disease can be seen to be abnormal by any other techniques. Early detection of coronary artery disease (including acute heart attack); early cancer detection and evaluation of the effect of tumor treatment; diagnosis of infection and inflammation anywhere in the body; and early detection of blood clot in the lungs are all possible with these techniques. Unique forms of radioactive molecules can attack and kill cancer cells (e.g., lymphoma, thyroid cancer) or can relieve the severe pain of cancer that has spread to the bone.
The nuclear medicine specialist has special knowledge in the biologic effects of radiation exposure, the fundamentals of the physical sciences and the principles and operation of radiation detection and imaging instrumentation systems.
Training required: Three years." Reprinted from Which Medical Specialist for You, ABMS. Revised, March 2000.
Other nuclear medicine information links and sources:
Obstetrics/GynecologyAmerican Board of Medical Specialties description: "A obstetrician/gynecologist possesses special knowledge, skills, and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians, and as a primary physician for women.
Training required: Four years plus two years in clinical practice before certification is complete.
Certification in one of the following subspecialties requires additional training and examination.
Critical Care Medicine: An obstetrician/gynecologist who specializes in critical care medicine diagnoses, treats and supports female patients with multiple organ dysfunction. This specialist may have administrative responsibilities for intensive care units and may also facilitate and coordinate patient care among the primary physician, the critical care staff, and other specialists.
Gynecologic Oncology: An obstetrician/gynecologist who provides consultation and comprehensive management of patients with gynecologic cancer, including those diagnostic and therapeutic procedures necessary for the total care of the patient with gynecologic cancer and resulting complications.
Maternal-Fetal Medicine: An obstetrician/gynecologist who cares for, or provides consultation on, patients with complications of pregnancy This specialist has advanced knowledge of the obstetrical, medical, and surgical complications of pregnancy, and their effect on both the mother and the fetus. He/she also possesses expertise in the most current diagnostic and treatment modalities used in the care of patients with complicated pregnancies.
Reproductive Endocrinology: An obstetrician/gynecologist who is capable of managing complex problems relating to reproductive endocrinology and infertility." Reprinted from Which Medical Specialist for You, ABMS. Revised, March 2000.
Other obstetrics and gynecology information links and sources:
A Career in Obstetrics & Gynecology, revised Dec. 1998, by the Association of Professors of Gynecology and Obstetrics and the Council on Residency Education in Obstetrics and Gynecology (CREOG) Joint APGP-CREOG Committee on Career Counseling.
To see an extensive and current list of articles on this topic, do a search in PubMed using the terms "medical students specialty obstetrics/gynecology." Substituting "career choice" for "specialty" will yield a slightly different list, including many of the same articles.
"Considering obstetrics and gynecology as a specialty: current attractors and detractors," Obstetrics and Gynecology," Aug. 1991, pp 308-312. PubMed abstract:
We surveyed senior students at 11 medical schools to identify the criteria they used in considering obstetrics and gynecology (OBG) as a career. Nearly half (49.6%) of the students responded. Their demographic characteristics compared well with national figures. Regression analyses identified 15 significant predictors of specialty choice among the 445 students who ranked OBG as one of their top four choices. More women than men chose OBG. Students attracted to the specialty liked contact with (mostly healthy) patients. They expressed strong beliefs on reproductive issues and perceived a need for more obstetrician-gynecologists. They associated their interests in operative procedures with certain risks and responsibilities. Physicians in OBG modestly affected their decision. Students who chose a different specialty wanted more variety in disease and patient mix. They wanted a more controllable life-style, particularly in residency training. They felt that the insurance costs and the risk of lawsuit detracted from OBG. These findings offer a stimulus for discussion between students and their advisors. Students need sufficient exposure to the specialty to help them assess the value they place on these specialty characteristics.
OphthalmologyAmerican Board of Medical Specialties description: "An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor, and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses.
Training required: Four years." Reprinted from Which Medical Specialist for You, ABMS. Revised, March 2000.
Other ophthalmology information and links:
OtolaryngologyAmerican Board of Medical Specialties description: "An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck.
An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of ears, nose, sinuses, throat, respiratory systems, face, jaws, and other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery, and the treatment of disorders of hearing and voice are fundamental areas of expertise.
Training required: Five years.
Certification in one of the following subspecialties requires additional training and examination.
Otology/Neurotology: An otolaryngologist who treats diseases of the ear and temporal bone, including disorders of hearing and balance. The additional training in otology and neurotology emphasizes the study of embryology, anatomy, physiology, epidemiology, pathophysiology, pathology, genetics, immunology, microbiology, and the etiology of diseases of the ear and temporal bone.
Pediatric Otolaryngology: A pediatric otolaryngologist has special expertise in the management of infants and children with disorders that include congenital and acquired conditions involving the aerodigestive tract, nose and paranasal sinuses, the ear, and other areas of the head and neck. The pediatric otolaryngologist has special skills in the diagnosis, treatment, and management of childhood disorders of voice, speech, language, and hearing.
Plastic Surgery within the Head and Neck: An otolaryngologist with additional training in plastic and reconstructive procedures within the head, face, neck and associated structures, including cutaneous head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and neural surgery.
The field is diverse and involves a wide range of patients, from the newborn to the aged. While both cosmetic and reconstructive surgery are practiced, there are many additional procedures which interface with them." Reprinted from Which Medical Specialist for You, ABMS. Revised, March 2000.
More info....
To see an extensive and current list of articles on this topic, do a search in PubMed using the terms "medical students specialty otolaryngology."
"The otolaryngologist as a role model," Ann Otol Rhino Laryngol, Nov. 1999, pp 1042-1045. PubMed Abstract: Throughout our daily interactions with medical students and residents, each of us, whether we like it or not, functions as a role model. Since role modeling is primarily a passive function - teaching by example - we may not be acutely aware of this role and its importance. In what respect is the concept of the role model important to otolaryngology-head and neck surgery? In addition to the function of specific training - teaching the trade - most of the literature on role modeling cites 2 major areas of significance: 1) influencing medical students' career choices and 2) facilitating socialization into the world of medicine with the establishment of an appropriate professional identity. This brief article reviews some of the current literature, catalogs those attributes that have beekn identified as those of excellent role models, and offers some thoughts as to what our specialty might consider in response to the challenges to medical education in the changing health care environment.
"The interface of academic and community practice in medical and graduate medical education," Archives of Otolaryngology--Head and Neck Surgery, Oct. 1996, pp 1041-1044. PubMed abstract: Historically, the interaction between academic departments of otolaryngology-head and neck surgery and the community practice of the specialty has been erratic, anecdotal, and often strained. A general sense of autonomy and isolationism that has characterized many university programs coupled with a paranoia on the part of many practitioners with respect to concerns about protecting their patient base have led to an uneasy relationship. Difficulties with managed care now threaten this relationship even more. It is clearly time to seek a solution that can enhance the educational opportunities for medical students and residents.
"Controllable lifestyle: a new factor in career choice by medical students,"
Academic Medicine, Oct. 1989, pp 606-609. PubMed abstract: To determine whether control of work hours (controllable lifestyle) was becoming an increasingly important factor in choices of specialties by medical students, data from three medical schools over the past ten, ten, and six years, respectively, were reviewed for the types of specialty training entered by students in the top 15% of their classes. Since students in the upper 15% of the class are likely to obtain the specialties of their choice, any change in the pattern of their specialty preferences probably reflects a general trend. Specialties that feature a controllable lifestyle (CL) were defined as anesthesiology, dermatology, emergency medicine, neurology, ophthalmology, otolaryngology, pathology, psychiatry, and radiology. Non-CL specialties were surgery, medicine, family practice, pediatrics, and obstetrics-gynecology. The results showed that the percentages of students entering CL specialties increased significantly at all three schools, the percentages of students entering non-CL specialties decreased significantly at all three schools, and there was no significant change in the percentage of students entering surgical specialties.
"The use of Part I National Board scores in the selection of residents in ophthalmology and otolaryngology," JAMA, Jan. 8, 1988, pp 240-242. PubMed abstract: A survey of ophthalmology and otolaryngology residency program directors was conducted to determine the extent to which National Board of Medical Examiners (NBME) Part I scores are used in selection of residents in these highly competitive specialty fields. Results from 218 completed questionnaires representing nearly 90% of all US ophthalmology and otolaryngology/head and neck surgery programs were analyzed. More than three fourths indicated that Part I NBME scores were used in selecting residents; more than half of the programs used these scores as a means to determine whom to interview. The direct use of NBME scores in the residency application process is widespread; however, such use of NBME scores is not consistent with the purposes of the National Board. The preeminent role of the faculty in the evaluation of medical students and in the assessment of their clinical competence needs emphasis.
PathologyAmerican Board of Medical Specialties description: "A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis, and treatment through knowledge gained by the laboratory application of the biologic, chemical, and physical sciences.
A pathologist uses information gathered from the microscopic examination of tissue specimens, cells, and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion, and monitoring of disease.
Training required: Five to seven years.
Certification in one of the following subspecialties requires additional training and examination.
Blood banking/Transfusion Medicine: A physician who specializes in blood banking/transfusion medicine is responsible for the maintenance of an adequate blood supply, blood donor and patient-recipient safety, and appropriate blood utilization. Pretransfusion compatibility testing and antibody testing assure that blood transfusions, when indicated, are as safe as possible. This physician directs the preparation and safe use of specially prepared blood components, including red blood cells, white blood cells, platelets, and plasma consituents.
Chemical Pathology: A chemical pathologist has expertise in the biochemistry of the human body as it applies to the understanding of the cause and progress of disease. This physician functions as a clinical consultant in the diagnosis and treatment of human disease. Chemical pathology entails the application of biochemical data to the detection, confirmation, or monitoring of disease.
Cytopathology: A cytopathologist is an anatomic pathologist trained in the diagnosis of human disease by means of the study of cells obtained from body secretions and fluids, by scraping, washing, or sponging the surface of a lesion, or by the aspiration of a tumor mass or body organ with a fine needle. A major aspect of a cytopathologist's practice is the interpretation of Papanicolaou-stained smears of cells from the female reproductive systems, the 'Pap' test. However, the cytopathologist's expertise is applied to the diagnosis of cells from all systems and areas of the body. He/she is a consultant to all medical specialists.
Dermatopathology: A dermatopathologist is expert in diagnosing and monitoring diseases of the skin including infectious, immunologic, degenerative, and neoplastic diseases. This entails the examination and interpretation of specially prepared tissue sections, cellular scrapings, and smears of skin lesions by means of light microscopy, electron microscopy and fluorescence microscopy.
Forensic Pathology: A forensic pathologist is expert in investigating and evaluating cases of sudden, unexpected, suspicious, and violent death as well as other specific classes of death define by law. The forensic pathologist serves the public as coroner or medical examiner, or by performing medicolegal autopsies for such officials.
Hematology: A physician who is expert in diseases that affect blood cells, blood clotting mechanisms, bone marrow, and lymph nodes. He/she has the knowledge and technical skills essential for laboratory diagnosis of anemias, leukemias, lymphomas, bleeding disorders, and blood clotting disorders.
Medical Microbiology: A physician who is expert in the isolation and identification of microbial agents that cause infectious disease. Viruses, bacteria, and fungi, as well as parasites are identified and, where possible, tested for susceptibility to appropriate antimicrobial agents.
Molecular Genetic Pathology: A molecular genetic pathologist is expert in the principles, theory, and technologies of molecular biology and molecular genetics. This expertise is used to make or confirm diagnoses of Mendelian genetic disorders, disorders of human development, infectious diseases and malignancies, and to assess the natural history of those disorders. A molecular genetic pathologist provides information about gene structure, function, and alteration and applies laboratory techniques for diagnosis, treatment, and prognosis for individuals with related disorders.
Neuropathology: A neuropathologist is expert in the diagnosis of diseases of the nervous system and skeletal muscles and functions as a consultant primarily to neurologists and neurosurgeons. The neuropathologist is knowledgeable in the infirmities of humans as they affect the nervous and neuromuscular systems, be they degenerative, infectious, metabolic, immunologic, neoplastic, vascular, or physical in nature.
Pediatric Pathology: A pediatric pathologist is expert in the laboratory diagnosis of deseases that occur during fetal growth, infancy, and child development. The practice requires a strong foundation in general pathology and substantial understanding of normal growth and development, along with extensive knowledge of pediatric medicine." Reprinted from Which Medical Specialist for You, ABMS. Revised, March 2000.
More info....
To see an extensive and current list of articles on this topic, do a search in PubMed using the terms "medical students specialty pathology." Substituting "career choice" for "specialty" will yield a slightly different list, including many of the same articles.
American Society for Investigative Pathology online brochure, "Pathology as a Career in Medicine."
College of American Pathologists web page, "Pathology Information for Students and Others."
The standard pathology textbook for medical students is the Robbins Pathologic Basis of Disease, by Cotran, Kumar and Collins--out in a 6th edition with a 1999 copyright. Academic libraries at universities with medical schools should have this, or be able to borrow it by interlibrary loan.
"Solving suspicious deaths: bruises, cuts, blood, saliva, hair, pigmentation, body temperature--they're just some of the clues for the forensic pathologist," The New Physician, Jan.-Feb. 2003, pp 12-20. Premed Pathfinder abstract: Just what is it about this specialty that attracts journalists and TV series producers? Doesn't dermatology have drama? This lengthy piece includes a look at the working life of Dr. Hamada Mahmoud, forensic pathologist for the West Virginia Office of the Chief Medical Examiner, and discusses how forensic pathology fits into criminal investigations. No, it's not like "CSI," "Crossing Jordan" or "Silent Witness." But a meticulous forensic pathologist can find a small, overlooked piece of evidence that indicates homicide. The most intriguing section of this article describes how Dr. Michael Baden, New York City's former chief medical examiner, investigated a death everyone else thought was an accidental overdose. Anatomical clues led him to believe the man died from burking, a murder method first noted in the 1800s. Baden's work helped convict the man's girlfriend and an accomplice of first-degree murder. The money is not as good as other specialties, though, ranging from $80,000-$120,000.
"A survey of first-year pathology residents: factors in career choice,". Human Pathology, Nov. 1987, pp 1089-1096. PubMed abstract: Pathology has become less attractive to US medical graduates by every measure available to us. In 1981, 2.3 per cent of US medical school seniors planned a pathology career; by 1986, a steady decline had reached 1.6 per cent. In absolute numbers, adjusted for the response rate to the AAMC questionnaire, this means that the 290 seniors entering pathology in 1981 had fallen to 205 by 1986. FMGs enter pathology through the matching program in greater numbers than any other specialty. Our data show that slightly less than a third of current first-year pathology residents are FMGs, mainly from Caribbean and Mexican medical schools. The decline in US graduates entering pathology has resulted almost entirely from a drop in the number of men choosing the field. In 1984, 286 male US graduates matched in pathology, but this number dropped to 150 in 1985 and 149 in 1986. The group entering in 1985 was the first who will need 5 years to be eligible for certification in the anatomic pathology/clinical pathology programs. During the same years, the 116 women who matched in 1984 were followed by 111 in 1985 and 100 in 1986. The effect of the American Board of Pathology's change in requirements is not easily analyzed. The figures for residents entering, given above, would suggest that the requirements discouraged men, especially, from entering the field. This hypothesis is supported by our questionnaire data and by anecdote concerning the pressure felt by graduating seniors to finish their postgraduate training as fast as they can and start paying off their average debt of $33,650. Pathology still seems to attract people who like to teach, study interesting case material, and do research. The percentage of PhD/MDs entering pathology is almost 10 times as high as their percentage among graduating seniors. Discouragement against entering pathology came from a perceived shortage of job openings, negative statements from other physicians (including pathologists), the addition of a fifth-year requirement, and lack of patient contact. The last is hard to account for because pathology would obviously not offer the opportunities to see patients that exist in the clinical specialties, but it was prominent in the concerns of residents answering our questionnaire. The picture that emerges from our data is one of a specialty passing through a difficult period in attracting new talent into its ranks. The first step in dealing with the problem would seem to be recognizing its existence.
"Career change: in quest of a controllable lifestyle," J Surg Res, Sept. 1989, pp 189-192. PubMed abstract: Over the past decade, top medical students are selecting "controllable lifestyle" (CL) specialties at an increasing rate. CL specialties include anesthesiology, dermatology, emergency medicine, neurology, ophthalmology, pathology, psychiatry, and radiology. The choice of "noncontrollable lifestyle" (NCL) specialties such as family practice, internal medicine, obstetrics/gynecology, and pediatrics was negatively affected by this trend. The effect of CL on the selection of surgical training by top medical students was variable. The purpose of this study was to determine if CL is a factor in career change by young surgeons during and after residency. Graduates of the University of Kentucky College of Medicine from 1975 to 1983 (n = 796) were questioned regarding the specialty they entered after graduation and whether they remained in that specialty as of March, 1988. NCL and surgery specialties showed a net loss of practitioners during the study period (P less than 0.005) and CL showed a net gain (P less than 0.005). When physicians changed specialties, the direction of change occurred from NCL and surgery to CL (P less than 0.05). Change from CL to NCL and surgery occurred infrequently.
PediatricsAmerican Board of Medical Specialties description: "A pediatrician is concerned with the physical, emotional, and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive health care to the diagnosis and treatment of acute and chronic diseases.
A pediatrician deals with biological, social, and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
Training required: Three years.
Certification in one of the following subspecialties requires additional training and examination.
Adolescent Medicine: A pediatrician who specializes in adolescent medicine is a multi-disciplinary health care specialist trained in the unique physical, psychological, and social characteristics of adolescents, their health care problems and needs.
Clinical & Laboratory Immunology: A pediatrician who utilizes laboratory tests and complex procedures to diagnose and treat disorders characterized by defective responses of the body's immune system.
Developmental-Behavioral Pediatrics: A developmental-behavioral specialist is a pediatrician with special training and experience who aims to foster understanding and promotion of optimal development of children and families through research, education, clinical care, and advocacy efforts. This physician assists in the prevention, diagnosis, and management of developmental difficulties and problematic behaviors in children, and in the family dysfunctions that compromise children's development.
Medical Toxicology: A pediatrician who focuses on the evaluation and management of patients with accidental or intentional poisoning through exposure to prescription and non-prescription medications, drugs of abuse, household or industrial toxins, and environmental toxins.
Important areas of medical toxicolgy include acute pediatric and adult drug ingestion; drug abuse; addiction and withdrawal; chemical poisoning exposure and toxicity; hazardous materials exposure and toxicity; and occupational toxicology.
Neonatal-Perinatal Medicine: A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies.
Neurodevelopmental Disabilities: A pediatrician who treats children having developmental delays, or learning disorders, including those associated with visual and hearing impairment, mental retardation, cerebral palsy, spina bifida, autism, and other chronic neurologic conditions. This specialist provides medical consultation and education and assumes leadership in the interdisciplinary management of children with neurodevelopmental disorders. They may also focus on the early identification and diagnosis of neurodevelopmental disabilities in infants and young children as well as on changes that occur as the child with developmental disabilities grows.
Pediatric Cardiology: A pediatric cardiologist provides comprehensive care to patients with cardiovascular problems. This specialist is skilled in selecting, performing, and evaluating the structural and functional assessment of the heart and blood vessels, and the clinical evaluation of cardiovascular disease.
Pediatric Critical Care Medicine: A pediatrician expert in advanced life support for children from the term or near-term neonate to the adolescent. This competence extends to the critical care management of life-threatening organ system failure from any cause in both medical and surgical patients, and to the support of vital physiological functions. This specialist may have administrative responsibilities for intensive care units and also facilitate patient care among other specialists.
Pediatric Emergency Medicine: A pediatrician who has special qualifications to manage emergencies in infants and children.
Pediatric Endocrinology: A pediatrician who provides expert care to infants, children and adolescents who have diseases that result from an abnormality in the endocrine glands (glands which secrete hormones). These diseases include diabetes mellitus, growth failure, unusual size for age, early or late pubertal development, birth defects, the genital region, and disorders of the thyroid, the adrenal and pituitary glands.
Pediatric Gastroenterology: A pediatrician who specializes in the diagnosis and treatment of diseases of the digestive systems of infants, children, and adolescents. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer, and jaundice and performs complex diagnostic and therapeutic procedures using lighted scopes to see internal organs.
Pediatric Hematology-Oncology: A pediatrician trained in the combination of pediatrics, hematology and oncology to recognize and manage pediatric blood disorders and cancerous diseases.
Pediatric Infectious Diseases: A pediatrician trained to care for children in the diagnosis, treatment and prevention of infectious diseases. This specialist can apply specific knowledge to affect a better outcome for pediatric infections with complicated courses, underlying diseases that predispose to unusual or severe infections, unclear diagnoses, uncommon diseases, and complex or investigational treatments.
Pediatric Nephrology: A pediatrician who deals with the normal and abnormal development and maturation of the kidney and urinary tract, the mechanisms by which the kidney can be damaged, the evaluation and treatment of renal diseases, fluid and electrolyte abnormalities, hypertension, and renal replacement therapy.
Pediatric Pulmonology: A pediatrician dedicated to the prevention and treatment of all respiratory diseases affecting infants, children, and young adults. This specialist is knowledgeable about the growth and development of the lung, assessment of respiratory function in infants and children, and experienced in a variety of invasive and noninvasive diagnostic techniques.
Pediatric Rheumatology: A pediatrician who treats diseases of joints, muscle, bones, and tendons. A pediatric rheumatologist diagnoses and treats arthritis, back pain, muscle strains, common athletic injuries, and 'collagen' diseases.
Sports Medicine: A pediatrician who is responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice), and the role of exercise in promoting a healthy life style are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation." Reprinted from Which Medical Specialist for You, ABMS. Revised, March 2000.
More info....
For an extensive and current list of articles on this topic, do a search in PubMed using the terms "medical students specialty pediatrics." Substituting "career choice" for "specialty" will yield a longer list, including many of the same articles.
"The effect of medical education on primary care orientation: results of two national surveys of students' and residents' perspectives," Academic Medicine, April 2001, pp 355-365. PubMed abstract: PURPOSE: To examine changes among a nationally representative sample of students and residents in their orientations toward primary care as reflected in their attitudes toward the psychosocial and technical aspects of medicine and their perceptions of the academic environment for primary care. METHOD: Confidential telephone interviews of stratified national probability samples of first- and fourth-year medical students and residents were conducted in 1994 and 1997. The 1997 survey included 219 students and 241 residents who had also been interviewed in 1994. Participants were asked about their attitudes toward addressing psychosocial issues in medicine and their perceptions of faculty and peer attitudes toward primary care. Responses were compared over time and across groups. RESULTS: Between the first and fourth years of medical school, there was a decline over time in students' reported orientations to socioemotional aspects of patient care (61.6% versus 42.7%, p =.001) and their perceptions that working with psychosocial issues of patients made primary care more attractive (56.3% versus 43.5%, p =.01). This pattern continued for 1997 residents (PGY-3), who were even less likely to say that addressing psychosocial issues made primary care more attractive (26.9%). For fourth-year students in 1994 who became PGY-3 residents in 1997, there was an increased perception that non-primary-care house officers and specialty faculty had positive attitudes toward primary care (20.8% versus 33.0%, p =.005; 28.3% versus 45.7%, p <.0001; respectively). CONCLUSIONS: Between 1994 and 1997 students and residents perceived a positive shift in the attitudes of peers and faculty toward primary care. During the course of their education and training, however, the students experienced an erosion of their orientations to primary care as they progressed through medical school into residency.
"The primary care specialties working together: a model of success in an academic environment," Academic Medicine, July 2000, pp 693-698. PubMed abstract: In today's environment of decreasing resources and increasing competition among clinical delivery systems, survival and ultimate success require interdisciplinary cooperation and, if possible, integration. Academic leaders at the University of California, Irvine (UCI), have developed a collaborative model in which faculty in family medicine, general internal medicine, and general pediatrics cooperate extensively in education, research, and patient care. Generalist faculty jointly administer and teach both a four-year "doctoring" curriculum for medical students and an array of integrated curricula for primary care residents, including a communication skills course. Several primary faculty jointly developed a collaborative unit for health policy and research, now an active locus for multidisciplinary research. Other faculty worked together to develop a primary care medical group that serves as a model for interdisciplinary practice at UCI. Recently, the university recruited an associate dean for primary care who leads the new UCI Primary Care Coalition, reflecting and promoting this interspecialty cooperation. This coalition does not represent a step toward a generic primary care specialty; UCI's generalist disciplines have preserved their individual identities and structures. Yet interdisciplinary collaboration has allowed primary care faculty to share educational resources, a research infrastructure, and clinical systems, thus avoiding duplicative use of valuable resources while maximizing collective negotiating abilities and mutual success.
"Effect of debt on U.S. medical school graduates' preferences for family medicine, general internal medicine, and general pediatrics," Academic Medicine, April 1996, pp 399-411. PubMed abstract: The authors assess the importance of educational debt in graduates' primary care specialty choices, and the variety of mechanisms through which debt may influence career decisions. Logistic regression models were used to identify significant predictors of the primary care specialty choices made by the 1991 and 1992 graduates of U.S. medical schools. These predictors were debt itself; other financial indicators; certain medical school characteristics; certain practice location plans; certain demographic factors; aspects of academic performance; and students' predisposition to a primary care specialty. Data for this study were gathered from a variety of sources at the Association of American Medical Colleges and from the Health Education Assistance Loans program. Both direct and indirect effects of debt were identified under specific conditions. The study revealed complex relationships between debt and the other predictors identified. For example, debt operated in relation to the levels of the graduates' expected incomes; debt from subsidized loan sources was significant for women who chose general internal medicine; debt was important in choices of family practice; and debt by itself was significant for those planning to practice in the West and who chose general internal medicine. Also, seemingly opposing effects of debt occurred. For example, in the family practice model used in this study, the threshold effect of debt was positive, while the linear effect of debt above the threshold was negative. Such variations help explain the conflicting findings of some past research. These and other findings prompt the authors to state that when investigating the effects of debt, it is not fruitful to ask what the effect of the debt is on all three primary care fields as a group. It is more appropriate to ask several questions, such as: under what conditions does debt influence specialty plans? Among which groups of students does debt have an impact on specialty plans? Are all of the primary care specialties similarly affected by the issues surrounding debt? Does the effect of debt change over time? The authors conclude by indicating possible policy implications of their findings.
Physical Medicine and RehabilitationAmerican Board of Medical Specialties description: "Physical medicine and rehabilitation, also referred to as rehabilitation medicine, is the medical specialty concerned with diagnosing, evaluating, and treating patients with physical disabilities. These disabilities may arise from conditions affecting the neuromuscular systems such as neck and back pain, sports injuries, or other painful conditions affecting the limbs, for example carpal tunnel syndrome. Alternatively, the disabilities may result from neurological trauma or disease such as spinal cord injury, head injury, or stroke.
A physician certified in physical medicine and rehabilitation is often called a physiatrist. The primary goal of the physiatrist is to achieve maximal restoration of physical, psychological, social, and vocational function through comprehensive rehabilitation. Pain management is often an important part of the role of the physiatrist. For diagnosis and evaluation, a physiatrist may include the techniques of electromyography to supplement the standard history, physical, X-ray, and laboratory examinations. The physiatrist has expertise in the appropriate use of therapeutic exercise, prosthetics (artificial limbs), orthotics, and mechanical and electrical devices.
Training required: Four years plus one year clinical practice.
Certification in one of the following subspecialties requires additional training and examination.
Pain Management: A physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings.
Pediatric Rehabilitation Medicine: A physiatrist who utilizes an interdisciplinary approach and addresses the prevention, diagnosis, treatment, and management of congenital and childhood onset physical impairments including related or secondary medical, physical, functional, psychosocial, and vocational limitations or conditions, with an understanding of the life course of disability.
This physician is trained in the identification of functional capabilities and selection of the best of rehabilitation intervention strategies, with an understanding of the continuum of care.
Spinal Cord Injury Medicine: A physician who addresses the prevention, diagnosis, treatment, and management of traumatic spinal cord injury and non-traumatic etiologies of spinal cord dysfunction by working in an interdisciplinary manner. Care is provided to patients of all ages on a lifelong basis and covers related medical, physical, psychological, and vocational disabilities and complications." Reprinted from Which Medical Specialist for You, ABMS. Revised, March 2000.
More info....
The Medical Student's Guide to Physical Medicine and Rehabilitation pages of the American Academy of Physical Medicine and Rehabilitation.
Careers in Occupational and Environmental Medicine, online brochure from the American College of Occupational and Environmental Medicine.
Plastic SurgeryAmerican Board of Medical Specialties description: "A plastic surgeon deals with the repair, reconstruction, or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk, and external genitalia. He/she uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well.
A plastic surgeon possesses special knowledge and skill in the design and surgery of grafts, flaps, free tissue transfer and replantation. Competence in the management of complex wounds, the use of implantable materials, and in tumor surgery is required.
Training required: Five to seven years.
Certification in one of the following subspecialties requires additional training and examination.
Plastic Surgery within the Head and Neck: A plastic surgeon with additional training in plastic and reconstructive procedures within the head, face, neck and associated structures, including cutaneous head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and neural surgery. The field is diverse and involves a wide range of patients, from the newborn to the aged. While both cosmetic and reconstructive surgery are practiced, there are many additional procedures which interface with them.
Surgery of the Hand: A plastic surgeon with additional training in the investigation, preservation, and restoration by medical, surgical, and rehabilitative means, of all structures of the upper extremity directly affecting the form and function of the hand and wrist." Reprinted from Which Medical Specialist for You, ABMS. Revised, March 2000.
More info....
A Career in Plastic and Reconstructive Surgery, from the American Society of Plastic Surgeons.
Preventive MedicineAmerican Board of Medical Specialties description: A preventive medicine specialist focuses on the health of individuals and defined populations in order to protect, promote and maintain health and well-being, and to prevent disease, disability and premature death. The distinctive components of preventive medicine include:
1. Biostatistics and the application of biostatistical principles and methodology;2. Epidemiology and its application to population-based medicine and research;3. Health services management and administration including: developing, assessing, and assuring health policies; planning, implementing, directing, budgeting, and evaluatingpopulation health and disease management programs; and utilizing legislative andregulatory processes to enhance health;4. Control of environmental health factors that may adversely affect health;5. Control and prevention of occupational factors that may adversely affect healthsafety;6. Clinical preventive medicine activities, including measures to promote health andprevent the occurrence, progression, and disabling effects of disease and injury; and7. Assessment of social, cultural, and behavioral influences on health.A preventive health medicine physician may be a specialist in general preventive medicine, public health, occupational medicine, or aerospace medicine. This specialist works with large population groups as well as with individual patients to promote health and understand the risks of disease, injury, disability, and death, seeking to modify and eliminate those risks.
Training required: Three years.
Certification in one of the following subspecialties requires additional training and examination.
Medical Toxicology: A specialist who is expert in the evaluation and management of patients with accidental or intentional poisoning through exposure to prescription and nonprescription medications, drugs of abuse, household or industrial toxins, and environmental toxins. Important areas of medical toxicology include acute pediatric and adult drug ingestion, drug abuse, addiction and withdrawal; chemical poisoning exposure and toxicity; hazardous materials exposure and toxicity; and occupational toxicology.
Undersea and Hyperbaric Medicine: A specialist who treats decompression illness and diving accident cases and uses hyperbaric oxygen therapy to treat such condtions as carbon monoxide poisoning, gas gangrene, non-healing wounds, tissue damage from radiation and burns, and bone infections. This specialist also serves as consultant to other physicians in all aspects of hyperbaric chamber operations, and assesses risks and applies appropriate standards to prevent disease and disability in divers and other persons working in altered atmospheric conditions." Reprinted from Which Medical Specialist for You, ABMS. Revised, March 2000.
More info....
PodiatryAmerican Podiatric Medical Association's Careers in Podiatric Medicine web page.
PsychiatryAmerican Board of Medical Specialties description: A psychiatrist specializes in the prevention, diagnosis, and treatment of mental, addictive, and emotional disorders such as schizophrenia and other psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders, and adjustment disorders. The psychiatrist is able to understand the biologic, psychologic, and social components of illness, and therefore is uniquely prepared to treat the whole person. A psychiatrist is qualified to order diagnostic laboratory tests and to prescribe medications, evaluate and treat psychologic and interpersonal problems, and to intervene with families who are coping with stress, crises, and other problems in living.
Training required: Four years.
Certification in one of the following subspecialties requires additional training and examination.
Addiction Psychiatry: A psychiatrist who focuses on the evaluation and treatment of individuals with alcohol, drug, or other substance-related disorders and of individuals with the dual diagnosis of substance-related and other psychiatric disorders.
Child and Adolescent Psychiatry: A psychiatrist with additional training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence.
Clinical Neurophysiology: A psychiatrist with expertise in the diagnosis and management of central, peripheral, and autonomic nervous systems disorders using a combination of clinical evaluation and electrophysiologic testing such as electroencephalography (EEG), electromyography (EMG), and nerve conduction studies (NCS).
Forensic Psychiatry: A psychiatrist who focuses on the interrelationships between psychiatry and civil, criminal, and administrative law. This specialist evaluates individuals involved with the legal system and provides specialized treatment to those incarcerated in jails, prisons, and forensic psychiatry hospitals.
Geriatric Psychiatry: A psychiatrist with expertise in the prevention, evaluation, diagnosis, and treatment of mental and emotional disorders in the elderly.The geriatric psychiatrist seeks to improve the psychiatric care of the elderly both in health and in disease.
Pain Managment : A psychiatrist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings." Reprinted from Which Medical Specialist for You, ABMS. Revised, March 2000.
More info....
To see an extensive and current list of articles on this topic, do a search in PubMed using the terms "medical students specialty psychiatry." Substituting "career choice" for "specialty" will yield a longer list, including many of the same articles.
American Psychiatric Association's Medical Education page.
American Academy of Child & Adolescent Psychiatry web site includes discussion of the child psychiatrist shortage.
"Recruitment into psychiatry: increasing the pool of applicants," Canadian Journal of Psychiatry, June 1999, pp 473-477. PubMed abstract: OBJECTIVE: To demonstrate that it is possible to identify the cohort of students in their first year of medical school from which future psychiatrists will be recruited. METHOD: During a 3-year period, all first-year medical students at the University of Maryland completed a form indicating their specialty preference. Of those students, 403 pursued the regular psychiatry curriculum, and 34 participated in an enriched behavioural science and psychiatry program. Specialty was chosen after graduation. RESULTS: The higher the first-year student ranked psychiatry as a preferred specialty, the more likely the student was to choose psychiatry as a career after graduation. This was true both for students in the regular psychiatry program and for those in the enriched program. Students in the enriched program were significantly more likely to choose psychiatry as a career than were "regular" psychiatry students who gave psychiatry the same ranking in their first year.b Freshman students who ranked psychiatry 4th or lower were not likely to choose psychiatry, no matter how much encouragement they received from their psychiatry departments. CONCLUSIONS: 1) Specialty preferences in the freshman year are predictive of future career choices. 2) An enriched medical school program in psychiatry can increase the number of graduates choosing careers in psychiatry. To help resource-poor medical schools increase the number of American medical graduates choosing psychiatry, the authors propose 2 inexpensive enriched programs.
"Managed care and the future of psychiatry," Archives of General Psychiatry, March 1997, pp 201-204. PubMed abstract: In 1987, one of us (T.D.) issued 3 predictions about the future of psychiatry, all of which have come true: (1) The promiscuous use of psychiatry to address a world of problems that are not biomedical and are unrelated to individual patients or their families has diluted the specialty's focus and made it what it should not be-a proposed solution to social ills. (2) The routinization of complex clinical tasks has inevitably resulted in downward decentralization, enabling lower-level professionals to take over responsibilities that were once the purview of physicians. (3) New knowledge about the brain and the mind have made it mandatory for psychiatry and neurology to mate for life to assure the future of both.
"Decline of U.S. medical student career choice of psychiatry and what to do about it," American Journal of Psychiatry, Oct. 1995, pp 1416-1426. PubMed abstract: OBJECTIVE: In 1994, only 3.2% of U.S. medical school graduates chose psychiatry, the lowest proportion since 1929. Success in recruiting such graduates is necessary to maintain adequate numbers of psychiatrists. The authors' goal was to gain an understanding of the determinants of specialty selection to ensure adequate recruitment. METHOD: They reviewed all recruitment-related English-language publications since 1959: 173 papers, 17 reports, and 10 books. RESULTS: They found that recruitment has been cyclical, with success from 1940 to 1969 and from 1985 to 1988, decline from 1970 to 1984 and from 1989 to 1994, and a possible small upswing in 1995. The 1940-1969 success began with 1) public recognition of a dramatic shortage of psychiatrists to serve in the military and treat casualties and 2) the fervor of the community mental health movement, which promised to prevent mental illness; massive resources were provided for psychiatry during this period. The declines were associated with 1) the failure of the community mental health movement to fulfill its promise, 2) psychiatry's becoming more biologically oriented and medically conventional, and 3) the effects of managed care and increased competition for patients. The psychiatry departments that have high recruitment rates are in public-supported schools, particularly in the South, or give considerable priority and resources for medical student psychiatric education. CONCLUSIONS: A study of the psychiatric workforce is needed to ascertain whether there is a surplus or a shortage of psychiatrists. Regardless, to ensure adequate recruitment, medical institutions and departments of psychiatry must commit resources for student education in psychiatry.
RadiologyAmerican Board of Medical Specialties description: "A radiologist utilizes radiologic methodologies to diagnose and treat disease. Physicians practicing in the field of radiology most often specialize in radiology, diagnostic radiology, radiation oncology, or radiological physics.
Diagnostic Radiology: A radiologist who utilizes x-ray, radionuclides, ultrasound, and electromagnetic radiation to diagnose and treat disease.
Radiation Oncology: A radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors.
Radiological Physics: A radiological physicist deals with the diagnostic and therapeutic applications of roentgen rays, gamma rays from sealed sources, ultrasonic radiation, and radio-frequency radiation, as well as the equipment associated with their production and use, including radiation safety.
Training required: Four years.
Certification in one of the following subspecialties requires additional training and examination.
Neuroradiology: A radiologist who diagnoses and treats diseases utilizing imaging procedures as they relate to the brain, spine and spinal cord, head, neck, and organs of special sense in adults and children.
Nuclear Radiology: A radiologist who is involved in the analysis and imaging of radionuclides and radiolabeled substances in vitro and in vivo for diagnosis, and the administration of radionuclides and radiolabeled substances for the treatment of disease.
Pediatric Radiology: A radiologist who is proficient in all forms of diagnostic imaging as it pertains to the treatment of diseases in the newborn, infant, child, and adolescent. This specialist has knowledge of both imaging and interventional procedures related to the care and management of diseases of children. A pediatric radiologist must be highly knowledgeable of all organ systems as they relate to growth and development, congenital malformations, diseases peculiar to infants and children, and diseases that begin in childhood but cause substantial residual impairment in adulthood.
Vascular & Interventional Radiology: A radiologist who diagnoses and treats diseases by various radiologic imaging modalities. These include fluoroscopy, digital radiography, computed tomography, sonography and magnetic resonance imaging." Reprinted from Which Medical Specialist for You, ABMS. Revised, March 2000.
More info....
Surgery--Colon and RectalAmerican Board of Medical Specialties description: "A colon and rectal surgeon is trained to diagnose and treat various diseases of the intestinal tract, colon, rectum, anal canal, and perianal area by medical and surgical means. This specialist also deals with other organs and tissues (such as the liver, urinary, and female reproductive system) involved with primary intestinal disease.
Colon and rectal surgeons have the expertise to diagnose and often manage anorectal conditions such as hemorrhoids, fissures (painful tears in the anal lining), abscesses and fistulae (infections located around the anus and rectum) in the office setting. They also treat problems of the intestine and colon, and perform endoscopic procedures to evaluate and treat problems such as cancer, polyps (precancerous growths), and inflammatory conditions.
Training required: Six years (including general surgery)." Reprinted from Which Medical Specialist for You, ABMS. Revised, March 2000.
Other colon and rectal surgery information and links:
American Society of Colon and Rectal Surgeons. Look to left and scroll down to "Residency Programs" and click.
Surgery--GeneralAmerican Board of Medical Specialties description: "A surgeon manages a broad spectrum of surgical conditions affecting almost any area of the body. The surgeon establishes the diagnosis and provides the preoperative, operative, and postoperative care to surgical patients and is usually responsible for the comprehensive management of the trauma victim and the critically ill surgical patient.
The surgeon uses a variety o diagnostic techniques, including endoscopy, for observing internal structure, and may use specialized instruments during operative procedures. A general surgeon is expected to be familiar with the salientfeatures of other surgical specialties in order to recognize problems in those areas and to know when to refer a patient to another specialist.
Training required: Five years.
Certification in one of the following subspecialties requires additional training and examination.
Pediatric Surgery: A surgeon with expertise in the management of surgical conditions in premature and newborn infants, children, and adolescents.
Surgery of the Hand: A surgeon with expertise in the investigation, preservation, and restoration by medical, surgical, and rehabilitative means, of all structures of the upper extremity directly affecting the form and function of the hand and wrist.
Surgical Critical Care: A surgeon with expertise in the management of the critically ill and postoperative patient, particularly the trauma victim, who specializes in critical care medicine diagnoses, treats and supports patients with multiple organ dysfunction. This specialist may have administrative responsibilities for intensive care units and may also facilitate and coordinate patient care among the primary physician, the critical care staff, and other specialists.
Vascular Surgery: A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intercranial vessels of the heart." Reprinted from Which Medical Specialist for You, ABMS. Revised, March 2000.
More info....
To see an extensive and current list of articles on this topic, do a search in PubMed using the terms "medical students career choice general surgery" Substituting "specialty" for "career choice" will yield a longer list, including many of the same articles.
"Where have all the surgeons gone? The typical surgeon's lifestyle is turning medical students away from the field, dwindling its numbers and threatening patient care. Can anything be done before it's too late?" The New Physician, Sept. 2002, pp 28-33. Fewer new MDs are choosing general surgery. Applications for general surgery residencies are down 30% in the last 10 years. And only 75% of the available residencies were filled by U.S. medical school graduates in the 2002 Match, with foreign medical graduates making up most of the difference. In rural health care, the shortage is serious; it's something larger medical communities are beginning to dread. Average annual salaries of $261,276 look great until one thinks about 14-hour days (more for a resident) and residencies stretching from 5 to 8 years. This articles suggests that more could be done to make these jobs fit for a human being.
"What the future may hold for general surgery. A position paper of the American Board of Surgery," Journal of the American College of Surgeons, Apr. 1995, pp 481-484. PubMed abstract: Developments in the specialty of general surgery have never been more important, nor have the opportunities for general surgeons been more exciting, than at the present. Technologic advances and the expansion of basic knowledge of surgical diseases have contributed to this renaissance of the field. It is of utmost importance that general surgeons seize the opportunity to participate in the education of medical students at all levels in the undergraduate years, seek to improve the surgical clerkships, and strive for the optimal learning environment for surgical residents. Through these means, the best and the brightest students will be attracted to general surgery as a career and will be retained in the practice of general surgery upon completion of residency training. Education of the student preparing for a nonsurgical career in the fundamental concepts underlying surgical therapy must be kept at the forefront of an undergraduate surgical curriculum. Integration and coordination of graduate surgical education in all of the general surgery-based specialties is an important obligation for the future, as knowledge expands in each specialty and the need for more specialty-specific education becomes apparent.
"Factors affecting choice of surgical residency training program," Journal of Surgical Research, June 2001, pp 71-75. Available free online. PubMed abstract: BACKGROUND: A significant problem facing American surgery today is the lack of participation from women and minorities. In 1995 and 1996, 15.1 and 15.8% of United States general surgical residency graduates were women. Of our 71 graduates in the last 12 years, 38% were women. The aim of this study was to identify the factors influencing our residents' choice of training program and the reasons why our program has a high percentage of female graduates. METHODS: Between 1989 and 2000, 27 women and 44 men completed general surgical training at our university and 44/71 (59%) responded to our survey. The age at residency completion was 34 +/- 2.2 years for men and 33.9 +/- 2.8 years for women. Fifty-five percent of men and 30% of women went on to fellowship training; and 36% of men and 20% of women are in academia. RESULTS: Factors influencing our graduates' selection of training program are: Only 23% of men had a female faculty as their mentor, whereas 90% of women had a male faculty as their mentor during training. Only 59% of men but 80% of women (P < 0.05) agreed that female medical students need role models of successful female faculty members. Fifty-five percent of men and 45% of women would encourage a female medical student to choose surgery as a career, but 82% of men and 50% of women would encourage a male medical student to do so. Ninety-one percent of men and 85% of women would choose surgery as a career again. CONCLUSIONS: A surgical residency training program with strong leadership, good clinical experience, and high resident morale will equally attract both genders. Women may pay more attention to the program's gender mix and geographic location. Copyright 2001 Academic Press.
Surgery--NeurologicalAmerican Board of Medical Specialties description: "A neurological surgeon provides the operative and non-operative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify function or activity of the nervous system; and the operative and non-operative management of pain. A neurological surgeon treats patients with disorders of the nervous system; disorders of the brain, meninges, skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution.
Training required: Seven years (including general surgery)." Reprinted from Which Medical Specialist for You, ABMS. Revised, March 2000.
Other neurological surgery information and links:
So, You Want to Be a Neurosurgeon? by Women in Neurosurgery, but geared to both genders.
Neurosurgery://On-Call's What is Neurosurgery? page.
Surgery--OrthopaedicAmerican Board of Medical Specialties description: "An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine, and associated structures by medical, surgical, and physical means.
An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries, and degenerative diseases of the spine, hands, feet, knee, hip, shoulder, and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system.Training required: Five years (including general surgery training) plus two years in clinical practice before final certification is achieved.
Certification in the following subspecialty requires additional training and examination.
Hand Surgery: A specialist trained in the investigation, preservation and restoration by medical, surgical, and rehabilitative means of all structures of the upper extremity directly affecting the form and function of the hand and wrist." Reprinted from Which Medical Specialist for You, ABMS. Revised, March 2000.
Other orthopaedic surgery info....
To see an extensive and current list of articles on this topic, do a search in PubMed using the terms "medical students career choice orthopedic surgery" Substituting "specialty" for "career choice" will yield a smaller list. Other fruitful searches can be done with the terms "orthopedics/trends," "orthopedics/education" and "orthopedics/economics."
"Is the orthopedic generalist moving toward extinction?" American Journal of Orthopedics, July 1999, pp 389-396. PubMed abstract: Medical students are influenced in their career choice by many factors. By government mandate, 50% of medical students from each graduating class should select primary care as their career choice. Peers and mentors contribute additional influences. The student's personality, preference for living in a rural or urban community, and the possible educational and cultural opportunities for self and/or family in a particular community are also influential factors. The medical student choosing orthopedic surgery as a professional career faces competition; there are four applicants for each residency opening, and the number of orthopedic residents allowed for each program is being reduced. The current belief of policy-makers both outside and within orthopedics is that there are "too many specialists of all kinds." The present article examines the factors that influence the medical student's choice in career selection and shows the present trend of clinical practices.
"Women in orthopedic surgery residencies in the United States," Academic Medicine, June 1998, pp 708-709. PubMed abstract: PURPOSE: To evaluate the effect that increased numbers of women medical school graduates have had on the composition of orthopedic surgery residencies, and to evaluate trends over time in the likelihood of women medical students to select orthopedic residencies. METHOD: The author analyzed JAMA's "Reports on Graduate and Undergraduate Medical Education" for the years 1977 to 1996, calculating the numbers of women and men in orthopedic surgery and other surgery residencies, and medical school composition. RESULTS: Although there have been modest gains in the number of women in orthopedic surgery training programs in the United States, women continue to choose orthopedics only one-seventh as often as do men. CONCLUSION: Orthopedics remains an unattractive career choice for women medical students compared with their men counterparts. Biases and stereotypes about women and about orthopedic surgery may account for this difference.
"Recent socioeconomic trends in orthopaedic practice," Journal of Bone and Joint and Surgery: American Volume, July 2001, pp 1097-1105. Article available free online.
"Expanding roles of the orthopaedic surgeon," Clinical Orthopaedics and Related Research, Apr. 2001, pp 46-51. PubMed abstract: Many sources predict an oversupply of orthopaedic surgeons in the United States continuing into the next 30 years. The most attractive solution to this problem is to expand the scope of orthopaedic practice by regaining direct patient access to orthopaedic specialty care, by developing and bringing new technologies and treatments to the marketplace quickly, and by developing alternatives to the typical orthopaedic practice such as expanding nonoperative care,
improving the quality of the office practice, and exploring volunteer opportunities.
Surgery-ThoracicAmerican Board of Medical Specialties description: "A thoracic surgeon provides the operative, perioperative, and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum, and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty.
Thoracic surgeons have the knowledge, experience, and technical skills to accurately diagnose, operate upon safely, and effectively manage patients with thoracic diseases of the chest. This requires substantial knowledge of cardiorespiratory physiology and oncology, as well as capability in the use of heart assist devices, management of abnormal heart rhythms and drainage of the chest cavity, respiratory support systems, endoscopy, and invasive and noninvasive diagnostic techniques.
Training required: Seven to eight years." Reprinted from Which Medical Specialist for You, ABMS. Revised, March 2000.
Other thoracic surgery info....
To see a current list of articles on thoracic surgery, try PubMed. Fruitful search strings would be:
thoracic surgery/trendsthoracic surgery/economicsthoracic surgery/educationUrologyAmerican Board of Medical Specialties description: "A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of, and skills in, endoscopic, percutaneous, and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.
Training required: Five years." Reprinted from Which Medical Specialist for You, ABMS. Revised, March 2000.
Other urology info....
"What is Urology? Information for medical students and prospective urology residents," by the American Urological Association.
To see a current list of articles on this topic, do a search in PubMed using the terms "medical students career choice urology" Substituting "specialty" for "career choice" will yield a slightly larger list. Also, try "urology/trends," "urology/economics" and "urology/education."
"What's new in urology," Journal of the American College of Surgeons, Aug. 2001, pp 179-2001.
"Managed care and its impact on American urology," Urology, May 1998, pp 31-35.
PubMed abstract: America's health care is undergoing a revolution. A previous private, fee-for-service, delivery system chiefly centered around hospital specialty care is rapidly being replaced by a commercialized system of managed care, controlled by businessmen whose prime motive is profit. Increasing emphasis of these managed care organizations is upon primary physicians who function as gatekeepers. While this new commercialized method of health care has been attended with reductions in the previous omnipresent health care inflation our country has experienced for the past several decades, its impact on quality of care and patient choice of physician remain a great concern. Especially vulnerable in this new system are our nation's academic centers, which, burdened with responsibility for education and research, are at a disadvantage in the competitive cost-based bidding for managed care contracts. Urology work force issues and the number of urologists in our nation remain another concern for urologists as they compete for access to patients in this new highly competitive environment. In a 1995 survey of a cohort of urologists in seven states, the respondents reported 35.8% of gross income came from managed care contracts, 86% reported the need for preservice approval for many diagnostic and therapeutic undertakings, 87% reported an inability to refer complex cases outside the Managed Care Organization (MCO) network, and 23% reported they were required to retain patients for treatment who they would have otherwise referred to a more qualified urologist. The majority of American urologists are reporting dropping gross revenues and increasing overhead in their dealings with managed care contracts. The advent of managed care is being attended with dropping gross revenues, increasing overhead costs and interference with the practice patterns of American urologists.
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