Reasons to do the ROAD specialties other than just lifestyle
I’m not going to lie, it’s a bit hard to write about medicine right since I’m not sure how everyone’s experiences are going and I don’t want to offend people whose experience isn’t similar to mine at this moment. But I came up with this post on the spur of the moment so I hope someone enjoys/learns from this.
In medicine, you’ll often hear about the “ROAD” specialties—radiology, ophthalmology, anesthesia and dermatology—together. It’s said that doctors in these specialties generally have less work hours and an easier lifestyle than doctors in other specialties. Generally, if you tell people you want to be a doctor in one of these specialties, they will likely assume that one of your major reasons for going into that field is the lifestyle.
Lifestyle is definitely something to consider in being a doctor, but there are plenty of other reasons that these fields are interesting as well. This post is to make a list of these reasons.
Also, otolaryngology (OHNS or ENT) isn’t usually part of the ROAD, but I did a rotation in it, and it is one of the most competitive specialties, so I’m including it in here too as a bonus. You’re welcome!
Radiology: I did radiology for four weeks. It was not my favorite rotation, but I was able to get a good sense of why people like it.
Because radiologists don’t have continuity of care, they don’t get as stuck in the weeds of social work and insurance and other non-doctoring things that say, internal medicine doctors get to deal with. They just get to do pure science, reading studies and doing procedures.
Radiologists can help a lot of people in a short amount of time. In clinic, you can see maybe 10-20 patients in a half-day, and in that same time, a radiologist can read and return maybe 100 studies. It is indirect patient help, but nevertheless, that’s a lot of people!
Radiologists get to interact mostly with coworkers who know what they’re talking about when they say “necrotizing pancreatitis” or “pyogenic liver abscess”, instead of having to spend a lot of time explaining very complex medical topics to people with no medical background who may not understand what you say even after you explain it several times.
A radiologist told me that he loves radiology because “there is just so much KNOWLEDGE to gain”. Radiology encompasses the entirety of the human body, so you spend time learning about all of the intricacies of the human body via imaging, and as you can imagine, there’s A LOT to discover.
The radiologists I got to work with were wonderful. It was clear that they knew a lot, but because they played a “behind the scenes role”, they lacked ego and they didn’t even come off as type A. They were relaxed AND smart, and they were lovely to talk to.
Ophthalmology
Sight is REALLY important. Eye diseases, even mild ones, immediately impact quality of life because they impact your ability to see and therefore impede your ability to interact with the world around you. Ophthalmology is really rewarding because it allows you to help people to gain their sight back again! That’s a pretty good motivation.
There’s no medicine equivalent for ophthalmology. There are cardiologists and cardiothoracic surgeons for the heart; there are neurologists and neurosurgeons for the brain. But the ophthalmologist is both the surgeon and the medical doctor for the eyes. You can medically manage the eye diseases that don’t require surgery and for the diseases that require surgery, you can fix them that way as well. For people who like both medicine and surgery and don’t want to give one up, ophtho is a good middle ground. (As a side note, it seems that all the ROAD specialties and ENT also fall into this category — mixed medical and surgical subspecialties.)
It’s a good balance of clinic and the OR (operating room). You can do a lot of procedures in the office, and if you like the OR, you can have that as well.
There’s a lot of cool technology to work with. For example, MIGS (minimally invasive glaucoma surgery) has completely revolutionized the treatment of glaucoma in the past decade, and LASIK has enabled people to literally not have to wear glasses anymore! Back when I was interested in ophtho, I spent a summer scanning people’s eyes using a huge scope that looked like something off of the Death Star. The tools ophthalmologists use are amazing, and the toolbox is only expanding.
Otolaryngology: I did two weeks of otolaryngology (officially OHNS for otolaryngology-head and neck surgery, but commonly called ENT for ear, nose and throat) and really liked it.
There are SO MANY structures in the head and neck…more than you would even think there are before studying head and neck anatomy. This means that ENT has a TON of variety. You can do huge head and neck cancer surgeries, or cochlear implant placements, or tonsillectomies, or even thyroid surgery or facial plastics. All of that falls into OHNS.
Like ophthalmology, there’s no medicine equivalent for otolaryngology. The otolaryngologist is both the medical doctor and the surgeon for the head and neck. So for example, people with hearing problems go to otolaryngologists to get cleared for hearing aids. ENTs manage allergic rhinitis and chronic sinusitis in clinic, and not always with surgery. ENT also gets weird, rare diseases like granulomatosis with polyangiitis (GPA), an autoimmune disease that can cause airway, lung and kidney problems. On tests, GPA always appears for the problems it causes in the lungs and kidneys. But I was shocked when I ended up operating on someone with GPA in the ENT operating room!
Again like ophtho, it is a very good balance of clinic and OR time, with lots of procedures that can be done in the office and plenty of short surgeries.
Anesthesia: I also did four weeks of anesthesia and really liked it.
You always think of surgeons as being essential to the OR, but you don’t always think about how essential anesthesiologists are. Without them, all surgeries would be exquisitely painful and intolerable!
As far as the subject itself, you get to apply a lot of the physiology you learn in the preclinical years that you think is useless until you do anesthesia. Tidal volume and minute ventilation? That determines how you help the patient breathe on the ventilator while they’re unconscious. Alpha and beta adrenergic receptors? Those are the receptors that are affected when you give anesthetic medications, which can cause changes in blood pressure, heart rate and respiratory rate. These are just two examples of the many things anesthesiologists think about.
One thing the anesthesiologists I worked with told me when I asked them “why anesthesia” is that they like how quickly they get results. The internal medicine doctor sees high blood pressure in clinic, prescribes amlodipine, and has the patient come back in two weeks to see if it works. The anesthesiologist sees high blood pressure, gives nitroglycerin in the OR and sees the blood pressure go down with immediate effect. A lot of anesthesiologists like that.
An anesthesiologist also told me, “it’s not just a science—there’s an art to it.” You have a wide range of anesthetic medications that you can give in a certain situation, and depending on the patient and procedure, you have to choose which medicine combination is the best for the patient. Anesthesia rarely falls into a formula.
Dermatology: probably the specialty that gets the most “you only did it for the lifestyle” comments.
Most people, thankfully, don’t have skin disease. But if you have a skin disease, people can see it and stare and make fun of you and ask prodding questions. This can really impact someone’s quality of life. Also, many skin diseases are painful and itchy. Again, not life-threatening, but quality of life can be greatly decreased.
Many systemic diseases have skin manifestations. For example, seborrheic keratoses are waxy brown papules that are very common with age. However, if you suddenly get a large number of seborrheic keratoses on your body, that can be sign of HIV infection or gastrointestinal cancer (Leser-Trelat sign). Neurofibromatosis, a rare brain and skin disease, is characterized by little firm tumors called neurofibromas that appear all over the body. It is also characterized by nerve sheath tumors of the eyes (optic gliomas, type I) or the ears (vestibular schwannomas, type II). There are many, many more diseases like this.
It crosses over with many different fields of scientific research, including immunology, genetics, microbiology, and even physics. Many MD/PhDs end up in dermatology because it crosses over really well with bench research. In line with this, it is a great research frontier with loads of topics that need more research and advancement, including hair, skin of color and dermatologic therapies.
There’s a lot of variety in dermatology. Like ENT and ophtho, it is both medical and surgical (though unlike those two, it is definitely closer to the medical side). In one day, you could go from excising epidermoid cysts like Dr. Pimple Popper to treating really bad stasis dermatitis or managing bullous pemphigoid. A dermatologist once told me that dermatology is “the family medicine of subspecialties” due to the wide variety of patients, diseases and procedures you get to see and do within the field.
A point of advice I have for people who are going into the ROAD specialties is to find some online teaching modules (for example, on YouTube) or read some research within the field (for example, on PubMed). Or, if you’re really nerdy, you can look for a med student-friendly textbook. This helps you gauge your interest in the academic material that the field has to offer. Even if you’re not planning to make your life revolve around medicine, a lot of your time in residency is going to be spent reading the latest research and learning from textbooks in your chosen specialty. So if you like the derm lifestyle but you can’t deal with the AAD Basic Dermatology Curriculum or Lookingbill and Marks’ Dermatology, then the field may not be for you. Also, if you do rotations in these specialties, you will certainly feel less confused having primed yourself with some basic knowledge of the field beforehand.
That’s all I have—hope it helps someone. Back to work for me!