Asked my friend on which field to get into for medcels

[4ever]

My friend also told me being a doctor isn't easy. Making it to med school in itself in an achievement and then going through all it and not making any real money for almost a decade isn't for everyone. @4ever

Honestly, Uni is 6-7 years. In theory that's quite long, but in practice Ik many people who took just as long for other degrees. Also you can stat your doctorate concurrently with your degree, so you might actually end up graduating with one of the highest academic degrees at a relatively young age. You don't even have to practice medicine afterwards, if you decide that it isn't for you.

While some people say that doctorates in medicine are quite easy, I think the quality range is just bigger. Looking at Mike Israetels thesis, I've seen a lot more impressive work from medical doctors.

Engineering mogs.

Getting """rich""" or at least well off, is harder as an engineer. The two paths I can see for engineers is being an irreplacable genius or starting a company. Starting a company as an engineer seems harder to me. Starting a medical office seems like opening a fastfood franchise in comparison. It's a proven concept.
For that reason most engineers will end up being employees, either as managers of some sort or in RnD.

You've probably seen this

In engineering, some concepts are probably more complex but the workload of medicine is just pretty high.

An other thing to consider would be the 70-30 female-male ratio in med vs 99-1 for engineering

 

[imontheloose]

Honestly, Uni is 6-7 years. In theory that's quite long, but in practice Ik many people who took just as long for other degrees. Also you can stat your doctorate concurrently with your degree, so you might actually end up graduating with one of the highest academic degrees. You don't even have to practice medicine afterwards, if you decide that it isn't for you.

While some people say that doctorates in medicine are quite easy, I think the quality range is just bigger. Looking at Mike Israetels thesis, I've seen a lot more impressive work from medical doctors.

Getting """rich""" or at least well off, is harder as an engineer. The two paths I can see for engineers is being an irreplacable genius or starting a company. Starting a company as an engineer seems harder to me. Starting a medical office seems like opening a fastfood franchise in comparison. It's a proven concept.
For that reason most engineers will end up being employees, either as managers of some sort or in RnD.

You've probably seen this
View attachment 4232052
In engineering, some concepts are probably more complex but the workload of medicine is just pretty high.

An other thing to consider would be the 70-30 female-male ratio in med vs 99-1 for engineering

The most common degree amongst millionaires is engineering likely due to the fact that it very well equips you for inventions. I know Oxford engineering stress only too well…

 

[Jason Voorhees]

Agreed, procedural specialties are usually paid better, less likely to be replaced by AI and more fun imo.


No pre-med.
You start medicine right after high school. Admission = grades + entry tests (pattern recognition / memory /cognitive abilities, sometimes science knowledge; then ranked compared to how all other participants performed). Then it’s straight to med school.

Residency = specialization.
After uni you pick your lane (surgery, derm, radiology, etc.). Most tracks are 5–6 years; a bit longer if you subspecialize (e.g., interventional radiology).

What’s competitive?
The fields with the best money + lifestyle mix tend to be the most competitive (shocker, despite med students always claiming that they aren't in it for the money or lifestyle). Same story in Europe.

How you actually get into competitive specialties:

• Connections > luck > profile > exams (rough order of impact? Depends on the chief physican and what he personally values).
• Build connections via internships/rotations (perform, be useful, leave a good impression) and research in the field / or related
• Exams matter, but they rarely beat a strong network + receipts
• the most competitive specialties tend to be Plastic Surgery and Dermatology
• location matters as well. Even less competitive specialties become competitive if you want to start in a popular, big city.

Germany salary reality:

• In hospitals, residents are roughly paid by seniority + hours, not by specialty.
  → A 4th-year psych resident ≈ a 4th-year neurosurgery resident.
• Pay is aight, not special. More “stressful” specialties often mean more hours = a bit more cash.
• Seniority = more room to negotiate. Salaries might deviate a bit more between specialties here. Not in a major way though.
• Special skills = more room to negotiate
• as a resident in a competitive field = no room to negotiate. All residents basically make the same
• Hours are long, salaries aren't really scalable
• Chiefs make good money, but they’re usually top experts/profs + managers/politicians inside the hospital

​

After residency: hospital → your own practice or stay in hospital to climb the hierachy?​

The move: Leave hospital → open/buy/partner in an outpatient clinic.

Why bother?

• Higher ceiling (PKV/cash pay, procedures).
• More control (hours, staff, pricing within rules).
• Scalable (more rooms, assistants, add-on services).

Nuanced reality of having your own outpatient clinic in Germany:

• Two pools of patients: public vs private
• Same work ≈ 1.8–3.5× revenue with private vs public (case/factor-dependent).
• Most patients = public → you must know the rules/budgets if you want to be profitable. Budgets are usually political / lobbying decisions and not always that fair
• Private/cash = no budget, faster payment—but you need demand + positioning. More like a "real business". Looked down upon by some.
• A mix of both is great imo but depends on specialty
• If you want to be a business, you'll have to deal with ruthless competition

What specialty to choose now based on this information?
You want procedural + outpatient-friendly + scalable + interesting

Negative example: Interventional Radiology can't be practiced in that outpatient setting very well. That goes for most very big surgical specialties like cardiothoracic, neurosurgery, etc. And since you don't even earn that much at the hospital for the intense work you do, unless you really like the field, specialties like cardiothoracic don't make that much sense to pursue here.

I could talk more about location, best countries to practice in, positive perspectives, challenges posed by investors, etc but let's see first if people are even interested in this.



If you invented a surgery that has been performed by globally respected surgeons, why can't you get into a residency program in the US? I am aware that it's really competitive, but based on what we know about you, it's hard to believe that there are that many candidates with a much better profile than you.
Or is it all just step score based and program leaders don't even look at anything beyond that?

Keep in mind that your italian education won't be recognized in the US (if you plan on practicing there). From what I've heard from a girl who did internships there, italian residency programs aren't that great (especially in surgical specialties). Surgical residents apparently don't get much hands on, practical experience. Senior physicians perform most of the real surgery, residents do ward work, assist in minor ways. Maybe that was just her hospital / experience. But I would look out for that.

Did you study med + dentistry, or how can you start max fac there? And is plastics your ultimate goal? How do you like Derm compared to plastics? Depending on your skills, you can do quite a lot as a dermatosurgeon as well (no osteotomies ofc).

Interesting. Seems like this is more of US being dominated by private healthcare difference than a public healthcare difference between germany and the US. But American doctors do make a bank tho.

 

[Jason Voorhees]

Also @4ever I asked AI if that outpatient thing and not making enough money to pursue neurosurgeon and cardiothoracic
point in AI and this is what it gave me what do you think?

 

[4ever]

Yes I could and I have a logger network even at Ivy League universities. Obv I could but I do not want to practice in US for many reasons.

• High liability,
• High hospital fees making the procedures I like (OBO, LF2/3) unrealistic. In Italy I could do for 60-80K (adjust for inflation) and keep 50K while hospital takes 10K, Hardware (Plates/screws) takes 10k, etc. Vs in America it would be $150K+ and hospital is taking 100K, hardware is taking 25K. Its ridiculous and not feasible for plastic surgery that requires hospitalization.
• Residency in italy is laid back ask with lots of time off compared to US and I am lazy and already have a nice life. I don't want to regress in comfort.
• I dont need prestige. My brand rides on being the best measured by the bottom line: results and super specialization. Obviously "Giant Implants" isn't relying on a facade of professionalism.
• I dont want to LIVE in the US for lifestyle purposes
• I dont want to pay US taxes. Now I have a system where I pay about 5% tax and it maxes out at 10% no matter how much I make. I might renounce citizenship and it can be 0%.

Im making the world work for ME, on my terms. Not going by convention.

This is IF I want to work at all. I am in a position to never work again if I wish. At least in the traditional sense, I would still create stuff (new inventions, run a company, etc)


I am well aware. I would stay in Italy but I could get it recognized in 1.) Dubai, 2.) Australia which are places I am more interested in living in than US.

Absolutely correct. It's a piece of paper allowing me to do it. But it's also very laid back and you are able to spend about half your time away. Plastic surgery residencies in Italy let you do 18 months of the 5 years abroad, which I would do Giant surgeries in Turkey with the surgeons I already work with, and get credit for them. I am already getting great experience in turkey.

It's not as if ANY residencies will be teaching the types of surgeries I am already working on. I just need the piece of paper.

I already know about the Italian systems and have assisted in surgeries in italy. Theres the official rules and theres how things really are in italy. Unlike US, thats how most countries work.

Maxillofacial surgery is MD only in Italy and all latin European countries (Spain, France, Italy, Portugal) For example Alfaro, Pags, Ram are all MD only. No dental degree needed. Which I really like.

And I would never be a derm. Might as well skip the residency and open a cosmetic clinic under your GP license and do all the same exact things (Lasers, filler, botox)

Really interesting perspective. Many people in Europe want to go to the US for the better salaries.
But your case isnt comparable to most anyways..

Locations I've been looking at are Switzerland (but might be better to go there as a specialist, since if you want to do something competitive, I can guarantee that it won't be just 5 years of residency).
Australia seems great as well. Nice lifestyle, great salary but high taxes.
Quite far removed from the rest of the world as well.

Didn't know that maxfac is MD only in southern Europe. I did an internship in maxfac but having to study dentistry made me rule it out.

Now I'm somewhat between derm and plastics. Gastro, maybe. Eye, maybe.

Derm can be great beyond fillers and Botox, you can do blephs and even face lifts. I also enjoy operating on skin tumors tbh. Procedures are usually quite quick, great for outpatient setting, etc.
You just need to find someone willing to teach you..

 

[4ever]

Also @4ever I asked AI if that outpatient thing and not making enough money to pursue neurosurgeon and cardiothoracic
point in AI and this is what it gave me what do you think?

View attachment 4232111View attachment 4232113

That might be the case in the US but not in Europe

 

[Jason Voorhees]

That might be the case in the US but not in Europe

So what's the point of all that suffering if you almost get paid the same anyway? Why bother becoming cardiothoracic/neurologist etc in Germany?

 

[4ever]

So what's the point of all that suffering if you almost get paid the same anyway? Why bother becoming cardiothoracic/neurologist etc in Germany?

Neurologists aren't paid that well in the US and Europe usually. They don't do many procedures (at least that has been the case in the past).

Yes, it makes little sense from a economic perspective, unless you really like it. Many people aren't that business/ ROI minded I guess.
I've heard that especially in cardiothoracic there are many foreign residents who get into it because it has a great reputation in their countries. People who know the system, avoid it. The trend is towards smaller interventions instead of big surgeries anyways.

If you want to ROI Max, choose a specialty that works well in an out patient setting.

 

[Dr. Mog]

A user @4ever asked me for advice on which field to specialize in. If it was finance or tech I could have pointed him in the right direction but I am absolutely clueless when it comes to medicine so I casually asked an old friend on his opinion.

Just for context he's an Attending Physician who graduated from an elite residency program in the US. The top of the top and has seen the economics play out for his entire class and this is what he told me. Even I learned a thing or two about the medical field

If you're chasing the best combination of money, longevity, and lifestyle. You have to go procedural and patient facing to beat AI. Dermatology is still the lifestyle king if you can get in but it's obviously insanely competitive.

Plastic Surgery has one of the highest earning potential but the training is a grind. Residencies for plastic surgery are generally much longer. He also stressed that the money is made by owning the practice and doing elective cosmetic cash. pay work.

Ophthalmology is very good. It's precise, clean,and has a great work life balance but not very high paying. Another thing he recommended is Orthopedic Surgery and Interventional Radiology (IR). Ortho is an income machine and IR is the only smart move in the Radiology space it's procedural and less likely to be automated. He says to avoid Diagnostic Rads as a long term. One more underrated thing he mentioned was Urology.

You can also consider high prestige positions like cardiologist/neurologist etc . They are highest prestige and extremely high paying. Interventional Cardiologist and Neurologists are usually the ones making the most money in a hospital. The true money in medicine is usually in cardiology and neurology $600K+ easily and that's a low balling it but the path is very long and lifestyle brutal. 3yrs Internal medicine residency+ 3yrs Cardiology fellowship+ 1-2yrs Interventional cardiology fellowship and this is after med School. Also it has one of the worst lifestyles in medicine with heavy emergency call for STEMIs(heart attacks)

Basically you have to decide what you're willing to trade a decade of your life for Neurosurgery/Cardiology money or insane competitiveness for the Derm lifestyle.In conclusion if your scores are high and drive are elite focus on Plastics, Derm, or Ortho.If you want a fantastic balance with a procedural focus look at Ophtho, IR. The key takeaway is procedures rule the earning landscape atleast in
the US medicine

You should have asked me Preston for med school advice, I would have directed you.
Ophthalmology, dermatology requires insane amount of money for instruments before even starting your career if you’re doing private practice and the patients wouldn’t wanna spend a heck ton of money all the time if you are in a salaried job at a hospital. Moreover surgical branches in the future have less scope than medical branches because many of the previous solutions to complications which were treated with only surgery are now being treated with just medicine and minor procedure. Sure you’ll make a heck ton but the risk is a lot too, as complications could be life threatening career stability is a lil low.

Medical (non surgical) branches like internal medicine, pediatrics even dermatology have more of a good stress free lifestyle as compared to surgical ones. Being a neurosurgeon seems cool on paper but irl the positive feedback/result from patients who have undergone neurosurgery is very low. Rather choose cardiothoracic surgery if you want a fancy name and good money but the seat is hard to get and takes an insane amount of dedication.

@4ever
@JohnDoe
@RealSurgerymax