in medicine you would choose if you wanted to work few, or at least predictable, hours

如果你希望工作時間少，或至少是可預測的工作時間，你會選擇醫學領域的工作。

while still making good money. This is the opposite – the worst lifestyle specialties

同時還能賺到好錢。這是一個相反的情況--最糟糕的生活方式專業

for the masochists. Dr. Jubbal, MedSchoolInsiders.com.

給受虐狂的人。Jubbal博士，MedSchoolInsiders.com。

To answer which specialties have the worst lifestyle, we first have to ask what makes

要回答哪些專業的生活方式最差，我們首先要問是什麼讓

for a good lifestyle? The general consensus is that it comes down to three primary factors:

好的生活方式？普遍的共識是，它歸結為三個主要因素。

(1) the hours you work, meaning the predictability and total number per week, (2) the amount

(1）你的工作時間，即每週的可預測性和總數，（2）金額

of money you make relative to the amount of work put in, and (3) the quality or substance

你所賺的錢相對於你所付出的工作量，以及（3）品質或內容

of your work. This may include the patient population, types of cases you most commonly

你的工作。這可能包括病人群體、你最常見的病例類型、以及你的工作。

deal with, or the amount of charting required. Don't overlook these factors, as dealing with

處理，或需要製作圖表的數量。不要忽視這些因素，因為處理

challenging patients or difficult and depressing outcomes day after day can drain you.

日復一日，具有挑戰性的病人或困難和壓抑的結果會耗盡你的精力。

So why would someone choose a specialty with a difficult lifestyle? The biggest factor

那麼，為什麼有人會選擇一個生活方式困難的專業呢？最大的因素是

is simply falling in love with the field. If you love excitement, unpredictability,

是簡單地愛上了這個領域。如果你喜歡刺激，不可預知性。

saving lives, and the operating room, you would love trauma surgery, and the challenging

拯救生命，以及手術室，你會喜歡創傷手術，以及具有挑戰性的

lifestyle would be very worthwhile. Another theory I've heard thrown around is that those

生活方式將是非常值得的。我聽到的另一個理論是，那些

who choose more challenging lifestyle specialties are workaholics at heart, and may prefer a

選擇更具挑戰性的生活方式專業的人，內心都是工作狂，他們可能更喜歡工作。

challenging and demanding work-life balance. They'll even brag about how bad their schedule

具有挑戰性和高要求的工作與生活平衡。他們甚至會吹噓自己的日程安排有多糟糕

is. Workaholism is a common coping mechanism, as it's easier to ignore one's inner demons

是。工作狂是一種常見的應對機制，因為這樣更容易忽視自己內心的惡魔

when you're working and don't have time to think about them.

當你在工作時，沒有時間去考慮它們。

The relative appeal of a specialty's lifestyle is also highly subjective. Most would say

一個專業的生活方式的相對吸引力也是非常主觀的。大多數人會說

dermatologists have a better lifestyle than trauma surgeons, but some would disagree.

皮膚科醫生的生活方式比創傷外科醫生好，但有些人不同意。

Neurosurgeons have some of the most challenging hours in the hospital, but they also have

神經外科醫生在醫院裡有一些最具挑戰性的工作時間，但他們也有

the highest compensation, which is why we joke that they make the most money but have

這就是為什麼我們開玩笑說，他們賺的錢最多，但卻有

no time to spend any of it. With that being said, know that this isn't a list of absolute

沒有時間去花任何的錢。說到這裡，要知道這並不是一份絕對的清單

truths, but rather a subjective list of stereotypes for which there are many exceptions. Let's

真理，而是一個主觀的陳規列表，其中有許多例外。讓我們

have fun with this list and not take things too seriously. And remember, there are always

對這份名單要有興趣，不要把事情看得太嚴重。請記住，總是有

exceptions to any generalization. If you want a challenging lifestyle, you should

任何概括都有例外。如果你想要一種具有挑戰性的生活方式，你應該

check out general surgery. The running joke amongst medical students is that you go into

檢查一下普通外科。在醫科學生中流傳的笑話是，你進入了

general surgery if you're either a masochist or couldn't get into any more desirable surgical

如果你是一個受虐狂，或者無法進入任何更理想的手術室，那麼你可以選擇普通外科。

specialty. This is obviously not the case and general surgery is a fantastic field with

專業。這顯然不是事實，普通外科是一個神奇的領域，具有以下特點

lots to love, but the reason medical students joke about this is four-fold.

有很多值得喜愛的地方，但醫學生之所以拿這個開玩笑，有四個方面的原因。

First, general surgeons work very challenging, unpredictable, and often long hours. Second,

首先，普通外科醫生的工作非常具有挑戰性，不可預測，而且往往時間很長。第二。

they're often dealing with pathologies and body parts that some would consider less appealing

他們經常處理的是一些人認為不太吸引人的病症和身體部位。

compared to other surgical specialties, like the intestines and its associated smells and

與其他外科專業相比，如腸道及其相關的氣味和

fluids. Third, they make less money than other surgical specialists. And fourth, it's the

流體。第三，他們賺的錢比其他外科專家少。第四，這也是

least competitive surgical specialty to match into for residency.

競爭最不激烈的外科專業，可以匹配到住院醫生。

That last point is why I always find it interesting when Caribbean medical schools brag about

最後一點就是為什麼當加勒比地區的醫學院吹噓自己的時候，我總是覺得很有趣

how many of their students matched into general surgery. You can watch my thoughts on Caribbean

他們的學生中有多少人匹配到了普通外科。你可以觀看我對加勒比海的想法

medical schools on my Caribbean playlist. General surgery used to be more, well, general,

我的加勒比海播放列表中的醫學院。普通外科過去更多的是，嗯，普通。

dealing with a wide variety of pathologies. In rural settings, this is still certainly

處理各種各樣的病症。在農村環境中，這當然仍然是

the case, as there are few surgical specialists nearby. But as the field of medicine moves

在這種情況下，由於附近沒有多少外科專家。但隨著醫學領域的發展

further towards greater specialization, general surgeons primarily deal with gastrointestinal

在進一步走向專業化的過程中，普通外科醫生主要處理胃腸道疾病。

and endocrine pathologies. If you want to work on the heart, you'll need to specialize

和內分泌病症。如果你想從事心臟方面的工作，你就需要專攻

as a cardiothoracic surgeon. To work on bones, orthopedic surgery. For complex soft tissue

作為一名心胸外科醫生。要從事骨骼、骨科手術。對複雜的軟組織

reconstruction or aesthetics, plastic surgery, and so on.

重建或美學，整形手術，等等。

But general surgery remains the default path for the medical student pursuing surgery,

但普通外科仍然是追求外科的醫學生的默認途徑。

but who isn't quite sure what kind of surgery to pursue. After general surgery, you have

但又不太確定要做哪種手術的人。普通外科手術後，你有

a wide variety of options for fellowship. For example, after general surgery residency

有多種多樣的獎學金選擇。例如，在普通外科住院醫師培訓後

you could pursue specialized cardiothoracic or plastic surgery training, but note that

你可以繼續接受專門的心胸外科或整形外科培訓，但要注意的是

this will require a few more years of training versus matching into a dedicated CT or plastics

這將需要更多年的培訓，而不是匹配到一個專門的CT或塑膠。

residency immediately after medical school. With the general surgery tract, the main drawback

醫學院畢業後立即住院治療。對於普通外科道，主要的缺點是

is the increased length of training. The main benefits are that you have more time to make

是訓練時間的增加。主要的好處是，你有更多的時間來使

a decision prior to committing to a subspecialization, and it's also a far less competitive path.

這是一條競爭性更小的道路，也是一個在致力於亞專業之前的決定。

In fact, many CT or plastic surgery applicants when applying to residency will apply to general

事實上，許多CT或整形外科的申請者在申請住院醫師時都會申請普通外科。

surgery residency as a backup, just in case they don't match.

駐場手術作為備份，以防他們不匹配。

If you're enjoying the video so far, let me know by hitting the thumbs up. And if you

如果你喜歡到目前為止的視頻，請點擊大拇指讓我知道。而如果你

think I've gone off my rocker, hit that thumbs down button.

如果你認為我不正常，請按下大拇指的按鈕。

Next up is primary care. That's right, primary care has one of the worst lifestyles, and

接下來是初級保健。這是正確的，初級保健的生活方式是最差的之一，而

you're probably scratching your head in disbelief. Allow me to explain.

你可能會不相信地撓撓頭。請允許我解釋一下。

You can become a primary care physician through various avenues, such as family medicine or

你可以通過各種途徑成為一名初級保健醫生，如家庭醫學或

internal medicine amongst others. Most wouldn't consider primary care doctors to have a challenging

其中包括內科醫生。大多數人不會認為初級保健醫生具有挑戰性。

lifestyle since you'll generally be working regular office hours, roughly 40 hours per

生活方式，因為你通常會在正常的辦公時間內工作，大約每40小時。

week. But that's only one component of a specialty's lifestyle. There are three other components

周。但這只是一個專業的生活方式的一個組成部分。還有其他三個組成部分

that translate to primary care having a poor lifestyle.

這轉化為初級保健有一個糟糕的生活方式。

First, as a primary care physician, you'll have lower compensation than most any other

首先，作為一名初級保健醫生，你的報酬會比其他大多數人低。

specialist, averaging roughly $240,000 per year. That's not bad, but the average specialist

專家，平均每年約為24萬美元。這並不壞，但平均而言，專家

makes on average $350,000 per year in comparison. If $240,000 sounds like more than you'd ever

與之相比，平均每年賺取35萬美元。如果240,000美元聽起來超過了你的想象

need, come back to me in 10 years when you have student loans to pay off, a mortgage,

需要，10年後，當你有學生貸款要還，有抵押貸款的時候再來找我。

family, car payments, and retirement to save for.

家庭、汽車付款和退休需要儲蓄。

Second, the amount of charting and paperwork in primary care is abnormally high, in some

第二，初級保健中的製圖和文書工作的數量異常之多，在一些

surveys averaging over 18 hours per week. In comparison, ophthalmology and anesthesiology

調查，平均每週超過18小時。相比之下，眼科學和麻醉學

are close to half that. And third, scope creep issues primarily effect

是接近一半。第三，範圍蠕變問題主要影響

primary care physicians, although anesthesiologists have also been subject to difficulties.

雖說麻醉師也遇到了困難，但初級保健醫生也是如此。

My mentor in medical school, who was an internal medicine primary care physician, advised me

我在醫學院的導師，是一位內科初級保健醫生，他建議我

and his other students that while medicine is a fantastic profession, he finds the changes

他和他的其他學生說，雖然醫學是一個神奇的職業，但他發現變化是非常大的。

in primary care quite disconcerting. He pointed to these three issues of reductions in reimbursement,

在初級保健方面，他的看法相當令人不安。他指出了這三個減少報帳的問題。

increases in charting, and midlevel scope creep as primary concerns.

繪圖的增加和中層的範圍蠕動是主要的關切。

OB/GYN is an often misunderstood field, and most in medicine would warn you about its

婦產科是一個經常被誤解的領域，大多數醫學界人士都會提醒你注意其

terrible lifestyle implications. Some obstetricians and gynecologists have extremely challenging

可怕的生活方式影響。一些產科醫生和婦科醫生有極具挑戰性的

lifestyles, and it doesn't help that their residencies have a reputation of being more

生活方式，而且他們的居住地有更多的聲譽，這也沒有幫助。

malignant than average. It's often a dreaded rotation by many third year medical students.

惡性程度高於平均水平。這往往是許多三年級醫學生所害怕的輪換。

But as an attending, your lifestyle will be highly variable depending on your practice

但作為一名主治醫生，你的生活方式將因你的工作而有很大的變化

type. It used to be the case that obstetrics was extremely challenging since babies don't

類型。過去的情況是，產科是極具挑戰性的，因為嬰兒不

care about your sleep schedule, and you would have to rush to labor and delivery on a moment's

關心你的睡眠時間，你將不得不在一瞬間趕到產房。

notice. But in recent years, OB has moved more towards the shift work model – a welcome

通知。但在最近幾年，OB已經更多地轉向輪班工作模式--這是一個受歡迎的做法。

change in most people's eyes. Gynecologists, on the other hand, could have

在大多數人的眼裡，變化。另一方面，婦科醫生可以有

a great lifestyle if they wanted to focus on primarily a clinic-based practice. Certain

如果他們想主要專注於以診所為基礎的實踐，是一種很好的生活方式。某些

gynecologic fellowships also offer a more procedural or surgical focus with relatively

婦科獎學金也提供了更多的程序或手術重點，相對來說，這是個很好的機會。

few emergencies. You can learn more about the field in our So You Want to Be an OB/GYN

少數急診。你可以在我們的《你想成為一名婦產科醫生》中瞭解更多關於這個領域的資訊。

video. It's no surprise that surgical specialties

視頻。外科專業毫不奇怪

have challenging lifestyles, but not all surgical specialties are created equal.

有挑戰性的生活方式，但不是所有的外科專業都是平等的。

Trauma surgery gets a bad rap since traumas are unpredictable and can come in at any moment,

由於創傷是不可預測的，隨時都有可能發生，所以創傷手術被說得很糟糕。

seemingly at the most inopportune hours of the night. Many trauma surgeons have shift

似乎是在夜間最不合適的時間。許多創傷外科醫生都有輪班

work schedules, particularly at larger and more established institutions. It's not like

工作時間表，特別是在較大和較成熟的機構。這並不像

you're relaxing on your day off and you suddenly get called in. You're either on or off service,

你在休息日放鬆，突然被叫去。你不是在服役，就是不在服役。

but still the hours can be long and challenging. But others at smaller groups may have to manage

但工作時間仍然可能很長，很有挑戰性。但在較小的團體中，其他人可能要管理

their own patients in house and aren't able to rely on more predictable shift work schedules.

他們自己的病人在家裡，不能夠依靠更可預測的輪班工作時間表。

Vascular surgery also comes with a particularly challenging lifestyle. You're specialized

血管外科也伴隨著一種特別具有挑戰性的生活方式。你的專業

enough that you're covering a large catchment area, meaning there will be emergencies happening

足夠大的覆蓋範圍，意味著會有緊急事件發生

just about every night that require intervention. And unlike other specialties where you act

幾乎每天晚上都需要干預。與其他專業不同的是，你的行為

as a consulting service and hand the patient off for management to the primary team, as

作為一項諮詢服務，將病人移交給主要團隊進行管理，因為

a vascular surgeon you will be rounding and managing your own patients.

作為一名血管外科醫生，你將負責巡視和管理自己的病人。

Neurosurgery is similar to vascular surgery in that regard, with the added complexity

在這方面，神經外科與血管外科相似，但增加了複雜性。

and burden of dealing with very sick patients with often poor outcomes. When you think about

和處理病重的病人的負擔，而且結果往往不好。當你考慮到

the types of patients that require brain surgery, you realize how many outcomes aren't as rosy

當你看到需要進行腦部手術的病人類型時，你會意識到有多少結果並不那麼美好

compared to some other surgical subspecialties. That was a surprisingly large factor that

與其他一些外科亞專業相比。這是一個令人驚訝的大因素，即

actually pushed me away from the field. Neurosurgeons are widely known for working the craziest

實際上是把我推離了這個領域。眾所周知，神經外科醫生的工作是最瘋狂的。

hours in the hospital, but they're also the highest paid specialists. If you want

在醫院的工作時間，但他們也是收入最高的專家。如果你想

to know more about neurosurgery, we made a So You Want to Be episode on it.

為了瞭解更多關於神經外科的資訊，我們製作了一集《你想成為這樣的人》。

There are certainly exceptions to all these trends. The ceiling for any given specialty

所有這些趨勢當然也有例外。任何特定專業的上限

is limitless, meaning you could always work more hours. Many of my friends and colleagues

是無限的，這意味著你總是可以工作更多的時間。我的許多朋友和同事

from medical school are now attending physicians, even in supposedly great lifestyle specialties,

從醫學院畢業的人現在都是主治醫生，甚至在所謂的偉大的生活方式的專業領域。

but because they're young, hungry, and want to set up a strong foundation for their future

但因為他們年輕、飢餓，並希望為他們的未來打下堅實的基礎。

professional and financial lives, they're willing to grind extra hard for a year or

在職業和經濟生活方面，他們願意在一年或一年內加倍努力工作。

two before dialing their hours back. Your practice type will also influence your

在將他們的工作時間調回之前，有兩個。你的業務類型也會影響你的

lifestyle. In the early years, those who enter private practice will be working much harder

生活方式。在最初幾年，那些進入私人診所的人將會更加努力工作

than those who are employed by a larger community or academic group. After all, they need to

比起那些受僱於更大的社區或學術團體的人。畢竟，他們需要

slowly generate a patient census, be hard working to get referrals from other physicians,

慢慢地產生一個病人普查，要努力工作，從其他醫生那裡獲得轉診。

and worry about all the aspects that go into running a successful business.

併為經營一個成功的企業所涉及的所有方面擔心。

While private practice may be more common in something like plastic surgery, being employed

雖然私人執業可能在像整形外科這樣的事情上更常見，但被僱用

is the norm, and straight out of residency you will be working more reasonable hours

是正常的，而且剛從居住地出來，你的工作時間將更加合理。

this way. Shift work is another arrangement that is more common in something like emergency

這種方式。輪班工作是另一種安排，在類似緊急情況下比較常見。

medicine. With shift work, it's easier to dial your hours down or up, depending on your

藥品。通過輪班工作，可以更容易地減少或增加你的工作時間，這取決於你的情況。

desired work-life balance. With surgery, shift work is less common, and you'll often have

理想的工作和生活平衡。在外科，輪班工作不太常見，而且你經常會有

to stay late if there are intraoperative complications. It's very rare for surgeons to work fewer

如果出現術中併發症，就會留到很晚。外科醫生工作時間少是非常罕見的。

than 60 hours until later on in their career. Although within surgery, there are some that

直到他們職業生涯的後期，才會有超過60小時的工作。雖然在外科內部，有一些

are more conducive to clinic, allowing for reduced weekly commitments, like urology.

更有利於臨床，允許減少每週的承諾，如泌尿外科。

If you want to learn more, we covered this in So You Want to Be a Urologist.

如果你想了解更多，我們在《你想成為一名泌尿科醫生》中談到了這個問題。

Lifestyle should not be your primary consideration when choosing a specialty, but it is important.

在選擇專業時，生活方式不應成為你的首要考慮因素，但它是重要的。

In fact, I would say most in their early to mid twenties underestimate its importance.

事實上，我想說大多數二十歲出頭到二十歲左右的人都低估了它的重要性。

Let me know with a comment below which specialty I missed. Or perhaps you're outraged and so

請在下面的評論中告訴我，我錯過了哪些專業。或者，也許你很憤怒，所以

offended that I listed your specialty in this video. Regardless, I'd love to hear from you

得罪了，我在這個視頻中列出了你的專業。不管怎麼說，我很想聽到你的聲音

with a comment down below. If you enjoyed this video, check out the best lifestyle specialties,

與下面的評論。如果你喜歡這個視頻，請查看最好的生活方式特產。

or the highest paid doctor specialties. Much love, and I'll see you guys there.

或收入最高的醫生專業。非常感謝，我們會在那裡見到你們。