Hate medicine...love surgery....but I want a life? What are my options?

[sunshinefl]

Gen surgery? Surprising, the crowds are very different.

Yeah, general surgery. I can’t explain it. I have no dog in this, I’ll be applying IM.

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[WedgeDawg]

So speaking of life during residency, what's the general consensus of most brutal to least brutal non-surgical residencies (FM, IM, EM, Peds, Neuro, Rads, PM&R, Derm, etc.)?

IM is killer, but even as an intern, you are balanced by relatively chill off-service weeks or months (a lot of residencies are 4 weeks of inpatient followed by 2 weeks of outpatient or elective). IM also gets dumped on by all the other services, and you're going to be the one admitting the nursing home patient with a suprapubic catheter, several stage 4 ulcers, who is also aphasic and demented and trying to fix all their chronic problems because no one rounded on them for 2 months in the nursing home and that's gotta be pretty emotionally draining. I honestly think IM is the most brutal non-surgical residency bar none. Thankfully its only 3 years.

Neurology is by no means an easy residency, and especially holding the stroke pager seems like grinds you down and its's 4 years instead of 3, but overall I think it's less intense than IM (far less critical care time, the biggest emergencies are strokes or are seen by neurosurgery, still has lots of clinic/outpatient, people decompensate on the floor less frequently).

EM is tough in terms of being busy when you're working and having wonky hours and also having relatively high acuity pretty frequently, but you don't work as many hours as other specialties overall.

Peds is kind of like IM lite. Definitely better hours, but inpatient peds, especially at a referral center, has some pretty sick kids, and that can be stressful. Has a good amount of outpatient to balance it out.

Rads probably overall "lighter", but you take call a lot as a junior resident and has a steep knowledge learning curve. You also have to do a prelim medicine or surgery year.

Anesthesia has a prelim or pseudo prelim year, but hours usually aren't terrible, though it's probably at least somewhat stressful as you do a lot of critical care and patients can go south in the OR fast. It seems to me that anesthesiologists become very competent very quickly though, and stressful situations (difficult airways, crashing patients, etc) become pretty routine by the end of residency.

PM&R... probably not very stressful though I'm not really sure about the details regarding what this residency actually entails.

Derm, lots of clinic, fast pace, but seems to overwhelmingly be one of the least stressful residencies.

FM, similar to derm in terms of lots of clinic and also being the first point of contact in the medical system for many undifferentiated patients; also does have some inpatient and surgery rotations which are likely tough, but again lots of outpatient to balance

Path... probably the most chill actual residency

Rad onc ... see the rad onc forum for an in-depth discussion, but my impression is that the actual residency isn't as brutal as some of these other ones above

***disclaimer*** i'm not a resident in any of these specialties so a lot of this is probably terribly inaccurate

 

[dangEras]

Welcome to interventional spine aka interventional pain management.

All outpatient. 50% of day is doing quick procedures (ESI, RFA, nerve blocks, kyphoplasties, SCS implants, vertiflex implants)

The other 50% of day is following up with your patients post procedure or seeing new consults.

If you take the pm&r route to pain, you'll get tons of anatomy, good work-life balance, and the most laidback residents as your coworkers.

 

[Angus Avagadro]

Welcome to interventional spine aka interventional pain management.

All outpatient. 50% of day is doing quick procedures (ESI, RFA, nerve blocks, kyphoplasties, SCS implants, vertiflex implants)

The other 50% of day is following up with your patients post procedure or seeing new consults.

If you take the pm&r route to pain, you'll get tons of anatomy, good work-life balance, and the most laidback residents as your coworkers.

Who fields the phone calls at night and on the weekend from the patients who had procedures and now claim to be in agony? Doesnt sound very appealing.

 

[SurgeDO]

Welcome to interventional spine aka interventional pain management.

All outpatient. 50% of day is doing quick procedures (ESI, RFA, nerve blocks, kyphoplasties, SCS implants, vertiflex implants)

The other 50% of day is following up with your patients post procedure or seeing new consults.

If you take the pm&r route to pain, you'll get tons of anatomy, good work-life balance, and the most laidback residents as your coworkers.

Pain management is doing kyphoplasties?

 

[Neopolymath]

Pain management is doing kyphoplasties?

And IR does them too. Seen both in person.

 

[dangEras]

Who fields the phone calls at night and on the weekend from the patients who had procedures and now claim to be in agony? Doesnt sound very appealing.

That kind of call happens ~1-2x per year and the response is always one and the same, 'go to the closest ER'.

 

[Mad Jack]

I have similar feelings.

I agree with the person who suggested ICU - the guy I worked with, that really made me want to go to med school, is an intensivist. He only does nights - a week on, a week off, so every other week completely free. I hate even the idea of rounds (I’m at the end of second year, but I participated in enough rounds as a nurse to know I hate them), and the good thing about being an intensivist is that most places I’ve worked don’t do night rounds.

You’d skip all the crap, manage the whole ICU every night, and pretty much just respond to emergencies and do procedures. You don’t even have management breathing down your neck, and my friend wore jeans with his white coat and nobody cared. Wear what you want, eat what you want, no supervision, no rounds. You just have to be willing to work nights, which I personally am fine with because I did it for eleven years. Night shift >>>> day shift, to be honest.

Unfortunately, all of the docs I worked with were IM then pulm/crit, so you have to make it through an IM residency with their endless rounds to get there.

ICU while hating pharmacology and long rounds? That's a big no from me champ

 

[JessyBee]

I am sorry you're going through this. You sound really burned out and good decisions usually aren't made when you're in that headspace. I have been in your shoes. Just know that everything is going to be OK and it will all work out in the end as long as you figure out how to clear your head so that you can make a decision that is best for you.

I was burned out once and almost dropped out of med school. I switched out of surgery to something different and now I show up to work with a smile plastered on my face because I am so happy of where I am. I wanted to be a surgeon since I was a kid, and I realized later on that it didn't fit my lifestyle and I found something else that I loved even more.

Do whatever you need to do to recharge your batteries/get a clear head (if your school has you on a home quarantine, then this would be the perfect opportunity). Talk to people in the field that you trust and share your concerns... there is a reason why you feel burnt out, so you need to figure out WHY that is before you can make a life-changing decision. Idk where you are in your med school career, but the first 2 years are awful, the clinical years are great (but can be VERY stressful because of boards, shelf exams, and... having to make life-changing decisions).

Assuming you continue down the med school path... your options will be to either get excited about surgery again or consider an alternative field. Both options are great... you just gotta pick whatever rings truest to YOU.

Oh, and as a random aside....... Have you considered ER medicine (shift work, no rounds, lots of procedures)? Or how about being an ICU doc (which would be 3 yrs of IM, 1 yr of pulm crit)? ICU docs do bronchoscopies, art lines, central lines, intubations, other minor procedures, etc. but primarily do shift work, so they have lives. Perhaps ICU medicine would be something for you to consider (as long as you don't mind seeing a lot of death, which is the only thing that deterred me from that profession). There is a fair amount of 'medicine' in ICU, but maybe the occasional procedure would be enough to recharge your batteries.

Wishing you all the best. You've got this.

What did you end up choosing?

 

[hungrydoc710]

Urology