Hey everyone, this is my first post on this forum. I am currently in a dilemma to the extent that I am literally loosing sleep from thinking about my residency choice. I started medical school thinking about IM. Yet, I just started my 4th and final year, and here I am, my mind being set on general surgery since mid-third year, have already lined up 2 letters from respected surgeons at my school, written my personal statement for surgery ,have done some research in a surgical project and done a lot of program research and now, almost a week into my Trauma sub-internship and realized that I no longer am as committed. I noticed that we usually (and erroneously) tend to associate fields with people- i.e I like IM b/c Dr.X was really nice to me or I really hated surgery b/c Dr.Y ignored me the whole time. I think that is what happened to me last year with IM attendings that never taught and 4 hour rounds where I was scutted out constantly by interns who were not stellar to begin with. I am trying my best not to think about malpractice and compensation and do what I envision myself doing in 30 years. My primary reason for picking something general like IM or GS is that they both have a lot of diversity and broadness. However, I am also interested in the intellectual challenge of IM and the analytical aspect that I never saw with the surgeons. Plus, lifestyle issues become really important now that I am on call every 3rd night and realize what it takes.
My questions: I am thinking about doing one year in categorical GS and leave in one year if I can't stand it and try to match in an IM program. Is that move frowned upon provided I don't mention it when I interview. Or should I do a prelim surg year and finish in 6 years if I decide to stay?

If someone is torn between my medicine and surgery, is GI/ interventional cardiology the obvious goals to strive for?? can you also do gen. medicine and GI at the same time in the same setting?

Any advice is appreciated and I am sorry for the long post

be careful, if its lifestyle youre after (after all, you said you cant picture yourself doing Q3) medicine might not be for you either.

Be careful who you associate with having a "good" lifestyle. The cardiologists I know and work with are as busy, if not more than most of the true "general" surgeons. GI is a bit more flexible...but GI still involves emergencies and late nights/early mornings. IM residency, though shorter and less physically demanding still has a lot of call, late nights, very ill patients, less tangible job satisfaction and a much broader knowledge base.

Be aware too of the general personalities of the specialties you are interested in. Its no fun to work with a bunch of jackasses whose egos exceed their knowledge or skills.

From a strategic standpoint, it is probably more difficult to match into a Gen surgery spot than it is to match into a descent IM spot. Since both options seem pretty equal, then do surgery at least one year and then make a decision based on that.

One of the most impressive IM residents I met was someone who had a preliminary year of surgery under his belt before he started IM. Nothing, and I mean nothing fazed this guy when it came to procedures to be done in the ICU. While the team would be talking about the contraindications to putting in a chest tube, this guy was already jabbing his finger into the patients thoracic cavity.

The technical confidence that comes with surgical training can be carried nicely into many of the procedural fields of medicine.

I was very torn between Medicine and Surgery (Gen Surg, Urology) myself. I loved Surgery for the procedures, but to be quite honest didn't like the fact that outside of the OR, the desire or ability/knowledge base to take care of sick patients is quite limited (in my humble opinion). The beauty of IM is that it teaches you to take care of and consider all of a patient's problems in formulating a treatment plan. I believe that MDs who are Medicine trained are much more comfortable with SICK patients whose underlying pathology isn't all that clear, and who have multiple problems. Surgeons (in general) like to have a single defined problem to address. And while a patient's care/needs/management issues doesn't stop after surgery, many of the surgeons I have trained with don't seem to recognize this fact. Unfortunately, patients don't all come with just one problem to be fixed in the majority of cases. I also found surgeons did a lot of things based on anecdotes and tradition, whereas decisions in Medicine even like GI and of course Cardiology are much more evidence based. While the "Eternal Medicine" attendings do persist and thrive, there are fields like Pulmonary, GI, Cards, Renal, where quick decisions and interventions have to be and are made quickly.

In my IM residency (Parkland) there's a story that goes around about a battle one night between Medicine and Surgery about what service a patient should go to. The IM and Surgery residents go around in circles, and finally, one of the Surgery residents says "this patient would probably be better served on a Medicine service", to which the Medicine resident replied "ALL patients in this hospital would be better off on a Medicine service." I think that sums up my point rather well.

Now one month into my GI fellowship, I can say my decision about Medicine has been validated. I LOVE what I do. I still need to be a good internist on a lot of the "what do we do now" issues that face Medical and Surgical patients, and endoscopy is FUN as well as expanding its therapeutic scope on a daily basis.

If you want to have a balance between cognitive medicine and procedures, I believe you are best served by doing IM and one of the procedural fellowships.

One other thing about procedures and IM residency -- comfort and competence with procedures in IM residency is based a lot on the type of program where you train. At Parkland, we pride ourselves on our procedural skills. I put in my own chest tubes, and was pretty good at it if I do say so myself, because I was TAUGHT well by my upper levels. But there are plenty of IM programs where you barely touch a central line or paracentesis kit.

In all seriousness, you could still apply to both IM and GS and rank both types of programs. It shouldn't be too late for you to do a SubI or AI and get medicine letters.

Feel free to PM me at any time. Good luck with your decision.

Wow..I thought I was reading my own post, right down to the research and two letters from surgeons (my appointment is actually tomorrow to get that 2nd letter...if he only knew). The only thing different is that I wanted to do Peds. Let me know what you decide and how you came about your decision if its before Sept. 1.

i am also having major conflict of interest and my application is due in 25 days for a general surgery categorical position. I love surgery. Its fascinating, it motivates me to learn, i can work all day and not notice, i love the complexity, the instant gratification...etc. However, during each of the three months that i've done surgery clerkships/electives my life has fallen apart. I find it impossible to do anything besides sleep when i get home, i don't talk to my loved ones as much, and i'm cranky more often. on the other hand, the only other specialty that i find interesting is medicine (i know, its weird). its ok, the cases seem repetitive, its alot more passive...however, i've noticed i'm happier outside of work, i talk more with people i care about, i talk to my patients more and have more compassion, i enjoy having an explanation for everything, the teaching is excellent compared to surgery, and i have a life.

However, now that i'm reading this post it seems that there pretty much is no life in medicine either. Is this true? I have no clue about medicine because I've had my head stuck on the surgery thing.

To those who responded, I am grateful for your advice and I greatly appreciate it. I am currently 2 weeks into my Trauma sub-I and the good news it has become better but I still cannot committ. However, I think I am going to attempt mathcing in a GS program and switch if I don't feel it is the right choice. There is a possibility that if I don't, I feel that somewhere down the road I will keep questioning my decision and have a lot of "what ifs?" to answer to. I would never know then what would have transpired in terms of a career if I never tried. Third year is such an imperfect system: you are on various services for 1 month throughout the year and you are expected to choose something to do for the rest of your life! That's the way it is.
Good luck everyone in your decisions as well and thanks again!