FOMO/Grass is always Greener/Specialties

[cjmurph14]

I'm just a measly M1 daydreaming here, but I was wondering if anyone had any input on the moment/decisions that sealed your specialty choice for you. Specifically, what was your moment when your specialty choice was made clear to you. Is it usually more of a "couldn't find anything else that I liked more" or "After X happened, I knew that I was chosen for X specialty by the X specialty gods." I probably romanticize attending life more than I should, but I just have a real fear of making the wrong choice. I'm a strong optimist so I can pretty much make any situation worthwhile for me, but I'm also a yolo kind of guy that wants to take every advantage and privilege that life has thrown me so far. The day-to-day work that I do in the future is going to be very important to me. I feel very lucky every day that I made the decision to withdraw from nursing school to pursue medicine everyday and I don't want to repeat that when residency time comes.

*Right now leaning into OBGYN---->maybe MFM or -----> maybe global health/mission work as an M1 male because I like how compelling the work can be. I'm trying to tread the line between having a strong impact in my work and having my wife and kids still love me. I've posted on this same line a couple times so sorry for beating a dead post if you've come across this before. Big thanks for the input.

---

Members don't see this ad.

 

[SpoiledMilk]

After I received my Step scores. No NSG for me.

 

[mrbreakfast]

Looking back years ago, I have a number of memorable clinical experiences that influenced my specialty choice, either towards what I ended up choosing, or away from other specialties. But ultimately, it'll be more of a culmination of experiences that'll help you decide. I can't actually cite this, but anecdotally I've heard that ~80% of med students go into a different specialty than they initially thought they would as an M1. You have a long time to make up your mind.

After I received my Step scores.

Yep. I know someone who chose the specialty he ended up going into literally on the day he got his step 1 score, which was ~30 points below what he needed for his previous "dream" specialty. For better or for worse, it used to be that you could effectively eliminate a number of specialties at the start of M3 year based on that score alone.

 

[voxveritatisetlucis]

If PDs do in fact end up replacing step 1 with step 2 scores, won’t it be too late by then to change speciality (in terms of research, recommendations, ECs etc.)

 

[mrbreakfast]

If PDs do in fact end up replacing step 1 with step 2 scores, won’t it be too late by then to change speciality (in terms of research, recommendations, ECs etc.)

Possibly, but if that does in fact happen, medical schools will respond by having medical students complete clerkships/take step 2 earlier, as many top medical schools seemingly have already done. The biggest benefit of making step 1 pass/fail is that, in the future, med school will likely be one pre-clinical year and three clinical years; both step exams will be done by early in M3 year.

It's also hard to say because, despite my story above, you can still apply, and match, with a "bad" step score. I personally know someone who matched ortho with a step 1 score in the low 220s, and someone else who landed multiple plastics interviews with a fairly average score on both steps. Derm's acceptance rate for a step 1 score 221-230 was 70% - that sounds awful, but isn't that much worse than the overall derm match rate of 85%. If someone is dead-set on applying for a competitive specialty, they'll likely end up applying regardless of what they get on step 2.

The sad part about my story of my friend who changed his specialty choice after getting his step 1 score is that there is a decent chance he could've still matched into that specialty. He just didn't want to risk it.

 

[collegestud2013]

If PDs do in fact end up replacing step 1 with step 2 scores, won’t it be too late by then to change speciality (in terms of research, recommendations, ECs etc.)

There have been studies/surveys sent out to PDs that have confirmed that most of them will use Step 2 CK as the new screening tool in place of Step 1, so that's probably going to happen in the near future. And yes it will make applying to competitive specialties with traditionally high USMLE scores even more risky than before since students will have spent more time building their app for that specialty before they find out towards the end of M3 year if their score is competitive. And some of those competitive specialties often require significant commitment upfront such as doing a research year in med school (which is most often done between M3 and M4 year but the decision to commit to one usually comes BEFORE med students get their Step 2 CK score back), so students are less likely to "back out" of a competitive specialty due to a low Step 2 score. My prediction would be that there will be increased applications per spot for the competitive specialties though they will come from applicants with below-average Step 2 scores for that specialty, while at the same time there will be more students in similar situations dual applying. Dual applying can mitigate some of the risks of applying one competitive specialty but has to be planned out well in advance (eg getting rotations and LORs for both specialties in time for ERAS, and having to block off enough time to interview for multiple specialties during interview season).

Taking Step 2 sooner may help solve some of these issues but since Step 2 is mostly focused on clinical content from the traditionally M3 core rotations, students who take it too soon can also do worse unless their school also starts clinical rotations earlier in response (some schools are already moving toward a 1.5 year or even closer to 1 year pre-clinical curriculum).

 

[Dral]

I went through third year sorta liking everything (except Neuro oddly, which is one of the things I went in wanting to do). During OB/gyn I thought about MFM for a bit.

Fourth year one of my first rotations was derm and I knew after the first day. It just clicked.

 

[painballer27]

I went through third year sorta liking everything (except Neuro oddly, which is one of the things I went in wanting to do). During OB/gyn I thought about MFM for a bit.

Fourth year one of my first rotations was derm and I knew after the first day. It just clicked.

With derm being quite competitive and generally requiring significant research, how did you go about getting your application together for derm so late?

 

[ortnakas]

The key is- to steal OP’s phrasing about romanticizing- to find the specialty you’ll like (or at least not mind) the boring parts for forever, not the specialty with a few exciting “sexy” parts you won’t want forever.

Like crazy House mysteries, don’t like CHF and COPD? Gonna have a bad time in IM.
Like schizophrenia, don’t like depression? Gonna have a bad time in psych.
Like Guillan Barre and CJD, don’t like strokes? Bad time in neuro.
Etc. etc.

TL;DR pick based on bread & butter not zebras

 

[Dral]

With derm being quite competitive and generally requiring significant research, how did you go about getting your application together for derm so late?

I had a PhD going into medical school with 8 or 10 basic science pubs already. In the months leading up to applying I did some derm focused research and worked on making connections. I also did an away rotation from which I got a really good letter of rec.