They say being a doctor is great — you’ll help people, make a lot of money, and work reasonable hours. But that isn’t the case for every doctor specialty. These are the specialties to consider if you’re looking for lifestyle — high pay and low hours.

The ROAD specialties, standing for radiology, ophthalmology, anesthesiology, and dermatology, have historically been the best for those optimizing for lifestyle. While that still mostly holds true, there’s much more to the story.

Look, we’re all human, and there’s no shame in you wanting to pursue a specialty that compensates you well without demanding you work crazy hours. The strange thing is that many people will virtue signal and claim that they don’t care about money or any of those supposed lesser desires that only other, amoral humans succumb to. That’s nonsense, and you shouldn’t fall victim to such virtue-signaling games with holier-than-thou thinking. Despite what many people say, it’s no coincidence that the most competitive and sought-after specialties in medicine also rank highly in pay, work-life balance, prestige, or some combination of them.

When doctors refer to a specialty’s lifestyle, they’re referring to two things: 1) how much money you’ll make, and 2) how hard you have to work, including total hours, irregular hours, or overall how taxing the job is.

In 2011, Paul Leigh, PhD, and colleagues sampled over 6,000 doctors to shed light on annual work hours across 41 specialties. The specialties with the highest average annual hours were vascular surgery, critical care, neonatal and perinatal medicine, thoracic surgery, and other surgical subspecialties. Specialties that on average worked the fewest hours included emergency medicine, physical medicine and rehabilitation, dermatology, occupational medicine, and pediatric emergency medicine.

In terms of compensation, the top three specialties are some order of neurosurgery, orthopedic surgery, and plastic surgery, with otolaryngology, cardiology, and gastroenterology trailing close behind.

Surgical Specialties

Looking at the list of specialties to choose from, you’ll notice that surgical specialties on average compensate more than non-surgical specialties, but surgeons also work longer hours. The average physician in the United States works approximately 60 hours per week — that’s after they complete residency training and are out in the real world. You bet that surgeons skew that above 60 hours per week, and non-surgical physicians are the ones more likely to work fewer than 60 hours per week. There are exceptions, but these are the trends.

But not all surgery is created equal. Within surgery, you should consider the types of emergencies you’ll have to deal with. As a trauma surgeon, you’ll be dealing with a wide variety of urgent cases demanding your immediate attention, from gunshot wounds to motor vehicle accidents, and everything in between. As such, your call days are going to be unpredictable and busy with lots of high-acuity work. Many who go into the field enjoy the excitement, but it’s often something that will wear on you, particularly as you get older. It’s far less fun to wake up and run to the hospital at 2 a.m. when you’re 40 compared to 25.

On the other end of the spectrum, plastic surgery is far less likely to have emergencies. Don’t get me wrong, there still are emergencies. For example, if you do microsurgery whereby you move tissues around the body and connect the blood vessels with microscopes, then you may come across a congested flap, meaning the blood supply is amiss. If you don’t promptly resolve the issue, the tissue will die. Or if you’re taking trauma call for face or hand, that will often require timely intervention, although many times it can wait until the morning. Overall, you’ll be called in far less than the average trauma surgeon.

At the same time, understand there’s variation within each of these specialties. If you’re doing a strictly aesthetics-based plastic surgery practice, you’ll be making more money and taking fewer calls compared to your reconstructive plastic surgery colleagues. Similarly, an orthopedic surgeon who specializes in trauma will have a busier call than one focusing on sports medicine.

Non-Surgical Specialties

If you’ve explored the world of physician bloggers, you’ll see a common pattern — they’re mostly in either anesthesiology or emergency medicine. That’s for good reason, as these are two fantastic lifestyle specialties.

With emergency medicine, you do shift work. You know when you’re going in and out of the hospital, and exactly how long you’re working. You don’t take work home with you either, which is nice. Because shifts are fixed in length and scheduled out in advance, you don’t have to worry about being called into the hospital at odd hours or having long cases one day that keep you in the hospital much later than planned.

Anesthesiology also offers much more flexibility in scheduling compared to something like surgery. If a surgery is going longer than expected due to complications or any other reason, the surgeon must stick it out and complete the case. Anesthesiologists, on the other hand, can swap in and out as needed. On average, you’ll have more predictable hours, and it’s not uncommon to see anesthesiologists reading on their computer or doing something else on the side during slower periods in a long case.

Radiology is unique in that you aren’t in charge of patient care directly. Instead, you’re primarily reading images, a step or two removed from patient care. As a result, you’re somewhat of a replaceable cog in a wheel, which can be a good or bad thing, depending on how you look at it. One key advantage is that you have more control over your schedule and are less susceptible to the unpredictabilities of patient care.

Other Considerations

Beyond your specialty choice, there are other considerations that will influence your attending lifestyle.

First, are you a cash-only practice or more traditional in accepting insurance? You can be a cash-based practice across many specialties, although some specialties are more conducive than others. For example, it’s not feasible to be a cash-based emergency medicine physician, but you do see primary care doctors who are cash only. The two that have the best cash-based options would be dermatology and plastic surgery, as both serve patient populations interested in elective aesthetic and cosmetic procedures, which are often not covered by insurance anyway. This is a distinct advantage to both specialties, as they are more resistant to policy changes regarding reimbursement. After all, they can always fall back on a cash-only practice if things went south.

Second, your practice setting will have a huge influence on your lifestyle. If you’re in a smaller private practice, you’re juggling both being a physician with running a business. That means clinical responsibilities and administrative ones, and you’ll be working longer hours than your colleagues who work at Kaiser or a larger community-based practice. In private practice, you work harder and can make more. If you go the traditional community route, you have much less to worry about, more regular hours, and while you won’t make as much, you’ll still make a very comfortable living.

Overall, lifestyle is an important consideration, but shouldn’t be your primary consideration. If you’re the kind of person that loves orthopedic surgery, you may not enjoy life as a psychiatrist, even though psychiatrists work far fewer hours on average.

This post appeared on Med School Insiders.

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