R-O-A-D to success or boredom?

I shadowed an Ophthalmologist today. Fun experience, lots of cool gadgets, get to “see” a lot, patients are a little sicker than in Derm but not sure if its for me. I guess to some extent, I am now thinking of more managerial or business-like functions within medicine like Hospital medicine where I get to do a lot of negotiating with doctors, communicating with patients and get to meet a lot of different people (and walk 6 miles a day!). I DO understand why people go into ophthalmology though, really great hours (we stopped seeing patients at 4), infrequent call schedules, not a lot of patients will die on you, nor do you really have too many emergencies. Plus there are some lucrative procedures with Lasik and Cataract surgery. Btw, I finally figured out why some people do not qualify for Lasik. Apparently, the procedure works by adjusting the CORNEA (not the lens) by making it more concave thus pushing the image focal point which falls in front of the retina in myopic patients to lie on top of the retina. However, some people are just born with thin corneas which are too thin for the procedure which would subject the cornea to perforation (which is REALLY bad). Also, I learned that myopia is actually due to the eyeball flattening out rather than a lens dysfunction and that presbyopia (far sightedness) is more due to the lens. Cool stuff, easy to do, can bill a lot for it, and the patients always live. And apparently there are subspecialties in ophtho like Neuroophthalmology where you get the harder and sicker cases but I guess not nearly as tough as neurology. Anyway, if I change my mind, I can probably do a nice 2 week rotation in ophtho during my Tuck year but for now, I think I’m leaning away from it.

So ruling out Radiology (no patient contact, don’t like anatomy that much), Ophthalmology (patients are that sick, not exciting or managerial enough, not that psyched about the eye itself), Anesthesia (gonna shadow in a couple of weeks but my pain clinic experience wasn’t that fun) and Derm (great for making money but the people aren’t super sick, I think I might get bored). Anyway we shall see, if Jack Wennberg is right and what we need to lower the cost and waste in health care is LESS procedures and acute care NOT more, primary care might just be the place to be in 10 years.