Last week Steven Goldberg (no relation), a former student of mine at the University of Miami School of Medicine, passed away of lymphoma at the age of 42. After 25 years of my teaching at the U of M, his name stands out in my mind, not because of similarity of name, but because of his brilliance and character. He was a true mensch.
Steve was born with transposition of the arteries, which required surgical correction. When he advanced in medicine, his goal was to become a pediatric cardiac surgeon and offer to other children what had been provided to him. He did just that, training at the same institution that had operated upon him as a child. He specialized in difficult cardiac procedures in children, including the kind of congenital defect that he had, as well as cardiac transplantation.
You can gain a better glimpse of his character through the YouTube video he prepared for LeBonheur Children’s Hospital last year. Within only a few days of his passing, there were hundreds of facebook postings by people whose lives he had touched.
Steve was also a skilled artist who illustrated significant parts of my books on Clinical Physiology Made Ridiculously Simple and Med’Toons. Here are three of my favorite cartoons that he drew:
From Med’Toons, by Stephen Goldberg, MedmasterT-helper cell function in the immune system. From Clinical Physiology Made Ridiculously Simple, by Stephen Goldberg, Medmaster
Steve will be greatly missed. He was the personification of the ideal physician.
I have always been fascinated by nature. Shortly after completing a residency in internal medicine I spent a year in Ghana practicing general medicine. I went on several African safaris, both in the bush and in clinic. The allure of going on a “safari” everyday is what drew me to a career in infectious diseases. I have maintained a fascination with tropical diseases and emerging infections. The HIV epidemic has led to a whole range of diagnoses, such as PCP and cryptococcal meningitis, which were exceedingly rare in the past. I currently work in a teaching hospital as an infectious diseases consultant, I run a county tuberculosis program, I have an HIV clinic, and I dabble in international TB/HIV research. The pros and cons of an ID career are:
Pros:
1) Many career options:
Research (opportunities in both basic and clinical research)
Teaching (ID doctors are an integral component of any training program; we tend to be well versed in ID and general medicine).
Clinical medicine (Job opportunities abound in academics and private sector)
Private sector (Jobs with pharmaceutical and research firms)
2) International opportunities: In tropical medicine/ HIV/ TB/ Malaria (recent increase in funding opportunities via Gates foundation, etc.).
3) Primary Care opportunities: If you like establishing long term relationships with patients, HIV care might be your calling.
4) Great Cases: Dengue, Malaria, MRSA, Tuberculosis, Ebola!
5) Decent work hours: May vary based on which career option you choose, but rarely does an ID doctor need to come into the hospital in the middle of the night. (I can’t say the same for our surgical and OB/GYN colleagues).
6) Respect of your colleagues: My impression is that ID is a highly respected specialty. There is no doubt that our services are invaluable to our colleagues.
Cons:
1) Pay: Not the highest paid specialty. Despite 2 to 3 years of ID fellowship after having completed an internal medicine residency one tends to get paid about the same as an internist. (Currently in the $120K- 200K range with some outliers).
2) Very few procedures: This may be looked on as a pro or a con depending on your desires. The lack of procedures largely is part of the reason for lower remuneration.
3) Continual rounding: This pertains to an academic setting. If you have done an ID consult rotation you are likely familiar with this notion.
4) Need for documentation: We get paid for our opinions. This requires detailed documentation.
I have been very satisfied with my choice to enter infectious diseases, but like any area of medicine it has its ups and downs. It is wise to make any career choice when fully informed.
*****
Which do you prefer – eBooks or print books? MedMaster is considering publishing eBooks. Your opinion will help.
One of the purposes of electives in the third and fourth years of medical school is to gain some experience in various medical specialties, to help decide on which field to enter. It is an important choice, since you will be working hard the rest of your life, and preferably it should be in a field that you truly enjoy.
In my case, having practiced neurology, ophthalmology, and family medicine at one time or another, in addition to lab research and teaching, I offer these considerations, but, of course, you will need to decide which ones are personally most relevant:
General vs Specialty Medicine?
Some people will find it more satisfying to practice in a very specialized area, since it is easier to learn one specialized field very well than keep up with the literature in a broad area. However, others may feel in a rut, always dealing with the same narrow range of problems. They may prefer to enter a broad specialty, such as internal medicine, family medicine, or general surgery and experience a wide scope of medicine.
More vs Less Patient Contact?
Some fields have less direct patient interaction, such as radiology and pathology. Others, particularly family and internal medicine, have much more. Are you more of a people person (children and/or adults) or would you prefer less patient contact? Emergency Medicine involves lots of patient contact, but the patient’s problems don’t follow you home, since ER medicine is not a continuity-of-care field; once the patient is admitted, a hospitalist takes over; or the patient’s primary physician continues the care if the patient is discharged.
High-Yield Practical Medicine?
All fields of medicine are practical in that you can help patients in any field, not just with bedside manner and laying on of the hands, but in the specific treatment measures unique to the field. Some fields are more satisfying than others in terms of well-defined practical results. Ophthalmology would be high on the list, since one can clearly assess an improvement of vision, whether by refraction or surgery. Neurology would be lower, but still there are many situations in which the neurologist provides critically important care.
People selecting General Surgery or a surgical subspecialty sometimes feel they are achieving more tangible results than in a specialty that relies more on medication. As one of my co-students, who chose surgery, put it: “I don’t want to be a pill-pusher.” His concern was that many pills are just placebos. Others feel differently. Family Medicine, despite the absence of surgery (beyond simple matters), can be very satisfying; there is a great need for physicians to coordinate the overall health care of the patient, and patients are often very grateful. But in Family Medicine, as in Internal Medicine and Psychiatry, when a patient improves, it sometimes can be difficult to tell whether it was a spontaneous or psychological cure or whether the medication truly was responsible for the improvement.
MedMaster 