Matching into competitive specialties in late 40s?

[wlf87]

I will be almost touching 50 by the time I get to thinking of fellowships (if I indeed go that route, instead of Family Medicine). I'm not talking about super-competitive specialties like Ortho/Derm/Neurosurgery etc. I am interested in Hemeonc or Radiology or Pathology, so what are the chances matching into those?

If one is looking at the age issue, I don't think there's much difference between the demands of Family Medicine and non-academic Hemeonc. Both are mostly outpatient/clinic based, with referrals to specialists as and when needed. Compared to FM, one would see more mortality/morbidity in malignant hematology, which would be both depressing & inspiring, depending on the circumstances. But many malignancies are being managed as chronic conditions (but I could be completely wrong on this). There's more opportunity to be part of clinical trials/research, which appeals to me. And I think we're on the cusp of major clinical breakthroughs in oncology, which could completely change disease outcomes (but they've been saying this for the past decade). Also, there's probably less burnout issues due to reasons that are common in primary care (PCP paperwork/patient management, doing mainly referrals, at least in big cities), also less worry of midlevel encroachment.

Rads/path would also be a good fit for me, but then I guess it would be hard to find jobs without some fellowships. Plus not much patient contact, which sounds both good and bad; Hemeonc sounds more likely to have a manageable level of patient contact than FM.

I believe residency & fellowship match is even more competitive & subjective than medical school, so FM makes more sense, but then 3 more years probably don't matter in the bigger picture (in case of hemeonc). And there's also probably some truth to why many don't want to get into primary care (besides money).

Would like to hear some informed opinions from those who know better than me, and maybe those who've been on this journey already.

Thank you!

---

Members don't see this ad.

 

[Goro]

First worry about getting into medical school, before thinking about specialties. Most of my students only know what they DON'T want to do by the end of year 3!

 

[wlf87]

Sorry for the confusion; I've been accepted and need to decide between a program leading to FM or go the regular medical school route (& then match). As you said, it's hard to know without clerkship experience, and even then people change their minds. And I could shadow only 1 FM doc in his 80s(after cold-calling 50+ docs; my own PCP refused saying HIPAA, and another simply made me sit in his office) who mostly referred his patients to specialists. (which would be very unfulfilling for me, and I know this is not the norm)

If I think rationally, I should do the FM program, but if I had thought rationally (& read SDN) then I probably would've never started on this journey in the first place. But then medical school is at a whole another level, so ignorance is not going to be bliss anymore. FM also seems like a fallback option for many, so I think perhaps I should go the regular route. But then I might fail to even match to FM (after reading too many posts here on how hard medical school is and people dropping out). So anyway just wondering if anybody in this age range has tried for something other than primary care, and perhaps hemeonc.

 

[Law2Doc]

Sorry for the confusion; I've been accepted and need to decide between a program leading to FM or go the regular medical school route (& then match). As you said, it's hard to know without clerkship experience, and even then people change their minds. And I could shadow only 1 FM doc in his 80s(after cold-calling 50+ docs; my own PCP refused saying HIPAA, and another simply made me sit in his office) who mostly referred his patients to specialists. (which would be very unfulfilling for me, and I know this is not the norm)

If I think rationally, I should do the FM program, but if I had thought rationally (& read SDN) then I probably would've never started on this journey in the first place. But then medical school is at a whole another level, so ignorance is not going to be bliss anymore. FM also seems like a fallback option for many, so I think perhaps I should go the regular route. But then I might fail to even match to FM (after reading too many posts here on how hard medical school is and people dropping out). So anyway just wondering if anybody in this age range has tried for something other than primary care, and perhaps hemeonc.

Since you are still debating the issue, go to the school that leaves the most options open. You have no way of knowing what you will like. I was surprised to see that many of the things I thought I wouldn't like I really enjoyed, and a lot of the things I thought I would like, I hated. Most med students change their minds at least once regarding specialty. Family med will always be there if you want it. Keep the other doors open until you see more. Don't focus on age -- if you aren't going for long surgical paths it probably won't have that much impact.

 

[bashwell]

I will be almost touching 50 by the time I get to thinking of fellowships (if I indeed go that route, instead of Family Medicine). I'm not talking about super-competitive specialties like Ortho/Derm/Neurosurgery etc. I am interested in Hemeonc or Radiology or Pathology, so what are the chances matching into those?

http://forums.studentdoctor.net/threads/does-age-matter-for-hematology-oncology-fellowship.1058789/

 

[Nasrudin]

DO NOT GET LOCKED INTO A PROGRAM THAT CHOOSES YOUR SPECIALTY--THAT ALSO CAUSES ME TO TYPE PSYCHOTICALLY IN ALL CAPS.

The specialties you mention are not that bad in terms of competition. Which is not corollated directly to age in any case. If surgical then you need to think about age and physical endurance. If rad or derm you need to think about ability to sprint for the entire 3.25 years of residency application material that you must accrue.

Don't let anyone choose your work for you.

 

[bashwell]

DO NOT GET LOCKED INTO A PROGRAM THAT CHOOSES YOUR SPECIALTY--THAT ALSO CAUSES ME TO TYPE PSYCHOTICALLY IN ALL CAPS.

The specialties you mention are not that bad in terms of competition. Which is not corollated directly to age in any case. If surgical then you need to think about age and physical endurance. If rad or derm you need to think about ability to sprint for the entire 3.25 years of residency application material that you must accrue.

Don't let anyone choose your work for you.

Totally agree.

Just a quick note: unlike derm, rads is not as competitive as it used to be in the past, or so I've heard over on the rads forum. Also rads is no longer as lifestyle friendly as it used to be (e.g. increased hours, nights, weekends, busy call, heavy volume, decreased reimbursements). Job market is tight too. Regardless, still a great specialty for the right person.

 

[jl lin]

Totally agree.

Just a quick note: unlike derm, rads is not as competitive as it used to be in the past, or so I've heard over on the rads forum. Also rads is no longer as lifestyle friendly as it used to be (e.g. increased hours, nights, weekends, busy call, heavy volume, decreased reimbursements). Job market is tight too. Regardless, still a great specialty for the right person.

But there is still a fair income to be had in rads--esp. interventional. Rads is one of those things to me where, it's a nice place to visit, but I wouldn't want to live there--same thing with derm.

Read Four Bad Reasons Medical Students Choose a Specialty: http://www.kevinmd.com/blog/2012/12/4-bad-reasons-medical-students-choose-specialty.html

I thought the part about students thinking anesth or ED would be good b/c of easy hours made me spit out my coffee. Sweet hours for anesth or ED? Really?

[Even though full-time emergency physicians put in about 35 – 40 hours per week, they work odd hours – evenings, nights, and weekends. Emergency physicians often spend their “off time” recuperating or “bouncing back” from late shifts. Odd hours can take a toll in the long term, something that’s difficult to understand when you are young. One student, who was always a night owl, considered a career in EM, figuring that she could “handle” the circadian rhythm disturbances. But, after doing her EM rotation, she saw how wiped out some of the attending physicians were and decided this would not be the best long term choice for her overall health and well being.] Unless you have had the pleasure of working rotating shifts or a lot of long nights-12 or >, you have no idea how this can beat you up, and you really feel it on your days off. I am saying this having works A TON of long off-shift hours, and I am someone who can generally hang well into the wee hours. But it's doing it over and over and over and having to hang in those last 3 hours and get home and crash, and then having to do it all over again. So even if you lean more toward being a night owl, like me, it's still beats you down. Personally, I think doing some 8 hour nights in the stretch is a little better--like 12 + 12 + 8 +8, b/c you can wind down toward the end of your stretch, but some people differ with this. Done a lot of different shifts. One thing I know is that if you want to have some kind of life, you need to have at least two whole days off in-between stretches of work--b/c you are going to end up feeling like crap after working that last night shift into morning, going home and napping or trying to stay up until normal bed time. I take a nap, and wake up early so that I can go back to night sleep hours, but then, you still lose out on recuperative sleep hours. If you sleep all day and you don't have to go back in, well, then you may not feel like sleeping at night. But if you come off 8's doing that, this transition is not so bad compared with coming off of 12's.

 

[jl lin]

Oh yea. And this part was hilarious:

[4. You don’t really want to practice the specialty you are choosing or you plan to practice for only a short time. I sometimes hear students say, “Well, I don’t really want to practice that specialty. My goal is to get out of clinical medicine or just practice one part of the specialty.” For example, some students think if they pursue EM, they can graduate and just work day or urgent care shifts. Or, someone may pursue a residency in several disciplines with the intent of gaining clinical experience and then “going into industry.” Others may choose a specialty that would make them a good candidate to become talk show hosts. While some people are successful when pursuing careers that are tangentially or barely related to medicine, most are not. If you know as a premedical or medical student that you really don’t want to practice medicine, perhaps you should give your medical school seat to someone else and consider what other careers might be more fulfilling]

Talk show host. . .

 

[QofQuimica]

Since you are still debating the issue, go to the school that leaves the most options open. You have no way of knowing what you will like. I was surprised to see that many of the things I thought I wouldn't like I really enjoyed, and a lot of the things I thought I would like, I hated. Most med students change their minds at least once regarding specialty. Family med will always be there if you want it. Keep the other doors open until you see more. Don't focus on age -- if you aren't going for long surgical paths it probably won't have that much impact.

Agree.

OP, if you know FM is for you, then the short track might make sense. But it doesn't sound like that's the case.

 

[Nasrudin]

I don't usually beg to differ with Q....but if you're taking everything that's crappy about IM--the 15 medication list, the 90 year olds with dizziness, the usual HTN/CAD/COPD/DM shuffle, and subtract out the freedom of discharge to the Great Myhtological Oupatient Work Up/Follow up with here you go SW'er see you next month mf'er....and then adding in months of OB and surgery training for God knows why...and then blocking the exit doors to cushy consultant gigs...and then paying dirt for a 50-60 hour weeks.

And then saying you can cut off this year here but this what you gotta do for the rest of your life so don't look around and don't ask any questions nor wonder what could've been, even before you really know what is....?

I gotta say that's just insane. And the people selling you that **** are university born and raised dogmatists with a leftist agenda that they cash in on your blood sweat and tears to feel swell about themselves on, as they fade into the useless twighlight of their twitty careers.

There's no equivocation with such propositions. The only appropriate response is getting up and walking the F out.

 

[wlf87]

Family med will always be there if you want it. Keep the other doors open until you see more. Don't focus on age -- if you aren't going for long surgical paths it probably won't have that much impact.

The way medical school sizes are increasing while residency spots stay the same, I think it would be a mistake for me to assume FM not getting more competitive come residency time. And the age factor came up in a few of my interviews and I can imagine it being even more prominent after the medical school wringer. I guess there's a fine line between being brave and foolish, and it will become clear only in hindsight, or probably by first year of medschool. But I understand the gist of what you're saying and it does make sense. And I was all for surgery until I saw a resident suturing a busted face, poking at it like like a ripe oozing tomato and I had to get out of the room. No ER either for similar reasons.

..and then paying dirt for a 50-60 hour weeks....And the people selling you that **** are university born and raised dogmatists with a leftist agenda that they cash in on your blood sweat and tears to feel swell about themselves on, as they fade into the useless twighlight of their twitty careers.

At the risk of incurring your wrath, I'm a bit of closet leftist myself (but learning fast), and while what you're describing doesn't sound horrible(after all what do I know), I can see the frustration of doing it for a lifetime (more paperwork than doctoring) and then seeing the pay differential on top of that would make it even worse... Actually I like the idea of FM, but I'm learning real life is more complicated. I also thought I was escaping being a corporate grunt, but it's not going to happen the way medicine is going. Beancounters think the same everywhere and I can visualize how the annual performance review for a doc would look like (In house referrals: 3.0/4.0; patientcare be damned). Biochem, cellbio, all the preclinical stuff one reads in a book is cool stuff, but that's not medicine, or a very miniscule part of it. And I can understand why some people say it's just another job. I crowed about ACOs in my interviews, but I'm not sure now after reading something like this:
http://www.kevinmd.com/blog/2013/06/hospitals-buy-primary-care-practices.html
http://www.kansascity.com/news/spec...s-more-physicians-join-hospital-payrolls.html
http://ideas.time.com/2013/07/02/the-epidemic-of-disillusioned-doctors/
http://commonhealth.wbur.org/2013/10/why-i-left-medicine-a-burnt-out-doctors-decision-to-quit

But I guess one always hope there's some happy middle ground, at least for oneself... sorry for the rant. I'm still a premed.

 

[Dullhead]

...wringer.

NVM the rest of your post - props for spelling and using "wringer" correctly.

 

[DrMidlife]

If the accelerated program is LECOM:
1. that schedule looks brutal
2. you can do FM or IM

It remains to be seen if there's any fellowship competitiveness issue with a 3 yr med program but I'd speculate this makes no difference after an IM residency. For instance. But I wouldn't try to go coastal or Mayo et al with this idea.

 

[bashwell]

The way medical school sizes are increasing while residency spots stay the same, I think it would be a mistake for me to assume FM not getting more competitive come residency time. And the age factor came up in a few of my interviews and I can imagine it being even more prominent after the medical school wringer. I guess there's a fine line between being brave and foolish, and it will become clear only in hindsight, or probably by first year of medschool. But I understand the gist of what you're saying and it does make sense. And I was all for surgery until I saw a resident suturing a busted face, poking at it like like a ripe oozing tomato and I had to get out of the room. No ER either for similar reasons.

My opinion (and that's all it is) is I think the application process to med school isn't entirely comparable to the application process to residency. Of course, GPA and MCAT scores are quite important to med school admissions committees. Perhaps on par with the importance of med school grades and Step 1 scores to residencies. But I don't think the rest is as comparable. In med school things like "race/ethnicity" and "extracurricular activities" (e.g. signing up with the Peace Corps) are often given significant priority at many (most?) medical schools. Med schools love to have a class that's full of diversity and unique life experiences and so on.

But when it comes to residency, the important things beyond Step 1 are things like research publications, which includes MS/PhD since many academic places want to groom young physician-scientists for faculty, LORs can make a significant difference (e.g. a LOR from a PD or other faculty member in the specialty you wish to pursue who know you well), clinical performance, etc. No one really cares about your experience climbing Mt. Kilimanjaro, or at least certainly not as much as when applying to med school. It's more about whether you can do the job.

I don't personally know where age fits into all this as I'm only a couple of years older than the average medical student and I don't think I look much older (if at all). More importantly, I haven't experienced any age bias or at least none I can detect. But when it comes to residency/specialty, I would tend to think it's more like what others here have already said - are you physically fit and healthy and able to do what the younger people are able to do in terms of running around the hospital, following up on patients, doing procedures, taking call, etc.? I'm guessing it's not like med school where age is maybe something the admissions committee looks at and thinks something like, will his/her age add to class diversity, or will it mean we're taking a spot away from a younger person? Some med schools may think it's fine since it adds to class diversity, while others may not since it's taking a spot away from a younger person with (in their view) more years of practice ahead of them (although of course there are many young people who squander their opportunities, and many older people who do far more in the comparatively fewer years they have than many younger individuals). Just my thoughts on this.

 

[Law2Doc]

... And I was all for surgery until I saw a resident suturing a busted face, poking at it like like a ripe oozing tomato and I had to get out of the room. No ER either for similar reasons...]

Just a tangent but I hope you realize you will be poking at your share of "ripe oozing tomatoes" throughout med school and residency even if you ultimately are shooting for a tame, office setting, FP career. Medicine is a very "roll up your sleeves and get your hand dirty" career. All of medicine. You really can't go into this career and not expect to see or be exposed to blood or other bodily fluids. We don't wear scrubs just because they look cool...

 

[Nasrudin]

The way medical school sizes are increasing while residency spots stay the same, I think it would be a mistake for me to assume FM not getting more competitive come residency time. And the age factor came up in a few of my interviews and I can imagine it being even more prominent after the medical school wringer. I guess there's a fine line between being brave and foolish, and it will become clear only in hindsight, or probably by first year of medschool. But I understand the gist of what you're saying and it does make sense. And I was all for surgery until I saw a resident suturing a busted face, poking at it like like a ripe oozing tomato and I had to get out of the room. No ER either for similar reasons.
At the risk of incurring your wrath, I'm a bit of closet leftist myself (but learning fast), and while what you're describing doesn't sound horrible(after all what do I know), I can see the frustration of doing it for a lifetime (more paperwork than doctoring) and then seeing the pay differential on top of that would make it even worse... Actually I like the idea of FM, but I'm learning real life is more complicated. I also thought I was escaping being a corporate grunt, but it's not going to happen the way medicine is going. Beancounters think the same everywhere and I can visualize how the annual performance review for a doc would look like (In house referrals: 3.0/4.0; patientcare be damned). Biochem, cellbio, all the preclinical stuff one reads in a book is cool stuff, but that's not medicine, or a very miniscule part of it. And I can understand why some people say it's just another job. I crowed about ACOs in my interviews, but I'm not sure now after reading something like this:
http://www.kevinmd.com/blog/2013/06/hospitals-buy-primary-care-practices.html
http://www.kansascity.com/news/spec...s-more-physicians-join-hospital-payrolls.html
http://ideas.time.com/2013/07/02/the-epidemic-of-disillusioned-doctors/
http://commonhealth.wbur.org/2013/10/why-i-left-medicine-a-burnt-out-doctors-decision-to-quit

But I guess one always hope there's some happy middle ground, at least for oneself... sorry for the rant. I'm still a premed.

Don't misunderstand the goal my hyperbolic language. FM is a great field if you like undifferentiated complaints, long term relationships with patients, and the widest possible variety of problems to solve on any given day. Thank goodness there's people who want to do it.

What I'm blasting at is a university based ideology that is looking to ensnare unsuspecting premeds. It sounds like DrML is the voice of sanity in that an FM locked program seems highly unlikely. Even so. Why rule out anesthesiology or PM&R. Or pathology or radiology. Derm, OB, peds, preventative medicine. Occupational medicine. Oncology. Surgery or psychiatry. EM. Whatever else I'm leaving out. All of it so different from each other that it's almost comical that it's all called medicine and that all us spent months mucking around in an anatomy tank together once upon a time.

Anyone coercing you through generalized propaganda, consciously or unconsciously, to forgo all those other possibilities, is not your friend. And surely isn't thinking about how to pay your massive debt either. To them more PCP's is like some holy mission in itself. Bear that cross at your own expense. One not worth an extra year in my opinion, obviously.

Despite what the NP lobby would have the lay public believe, there's no shortcutting in medicine. As DrML says, a shorter program is a more brutal one. There's room for streamlining and getting to clerkships sooner. Some of the Ivies I heard were doing this. But not by reducing the number of options in draconian fashion.

 

[bashwell]

Just a tangent but I hope you realize you will be poking at your share of "ripe oozing tomatoes" throughout med school and residency even if you ultimately are shooting for a tame, office setting, FP career. Medicine is a very "roll up your sleeves and get your hand dirty" career. All of medicine. You really can't go into this career and not expect to see or be exposed to blood or other bodily fluids. We don't wear scrubs just because they look cool...

By the way, this reminds of "The Goo Tolerance Index: a foolproof method for choosing a medical specialty"!

(I should add general radiologists still can do lots of procedures so they may not be quite as goo free as the paper indicates!)

 

[TheTao]

I'm middle age and also interested in HemeOnc, with Pathology a close second.

Just an FYI that you're not alone in thinking about these fields at this age.

 

[bashwell]

A hopefully helpful difference between specialties like path vs rads vs heme/onc is whether you tend to like the basic sciences or clinical sciences more since you'll essentially have to become an expert in whatever field you choose, with the commensurate time spent reading books, medical journals, attending conferences, etc. in your field. Are you happy studying all the minutiae of your field? Obviously there are lots of other differences, and it's almost always good to do rotations in each to see for yourself, but this basic distinction might be helpful to have in the back of your mind As you go through med school.

 

[wlf87]

@Nasrudin you make really good points. I'm bit fixated on the age factor (rightly or wrongly), which is driving a lot of my decision making. But it looks like the age issue should not be a reason enough to decide on FM. And an extra year is probably not worth it. The program is not restrictive; I guess one can change their mind later in the process, but this won't happen until rotation time, and by then it would be too late to accumulate all those ECs to get into anything competitive. And the step scores might also take a hit. And this seems like bending the rules to sneak into something the adcoms did not really consider me for and PDs might see it along same lines. As QofQuimca pointed, it makes sense only if one wants to go for sure into primary care.

@TheTao good to hear somebody doesn't think they're over the hill yet! good luck!!

I'm still sorta undecided, but thanks for the responses, everyone! Not sure how you find the time, but your input has been very helpful!!

 

[QofQuimica]

I don't usually beg to differ with Q....

And you're not differing with me here, except in degree of hyperbole. I did advise the OP against doing the short track, and for exactly the reason you've said: it locks him into FM when he isn't sure he wants a FM career. The only people who should consider a FM short track are people who are sure they want to do FM. There are some folks out there who've been involved in FM in other capacities besides as a physician, and becoming an FP is the whole reason why they're going to med school. The short track can make excellent sense in certain select cases like that.

 

[sazerac]

I was sure I wanted to do FM. I'm an older student, born in the Nixon administration. I only had experience with FM physicians. I liked the work. I even knew which clinic I was going to join when done with medical school.

I'm a third year now, and I do know that I don't want to do FM anymore. I'll probably still do something in primary care. Not interested in any fellowships. But things change once you are on the inside. I'd be super wary of committing to one specialty (or two) before you even started.

If you graduate from a US medical school, FM will always be an option.

 

[wlf87]

I was sure I wanted to do FM. I'm an older student, born in the Nixon administration. I only had experience with FM physicians. I liked the work. I even knew which clinic I was going to join when done with medical school.

I'm a third year now, and I do know that I don't want to do FM anymore. I'll probably still do something in primary care. Not interested in any fellowships. But things change once you are on the inside. I'd be super wary of committing to one specialty (or two) before you even started.

If you graduate from a US medical school, FM will always be an option.

Thank you for your insight. I thought I had made up my mind, but after seeing what you wrote, it's better I change it. If you don’t mind, what made you change your mind about not doing FM , since you had quite a good idea and you want to go into primary care anyway? I thought FM was more suited than IM for primary care because it trains you more in the outpatient procedures.

What I really like about FM is the variety and flexibility, location-wise and practice-wise, which would make for a “richer life experience.” (I guess that’s what all primary docs would probably label it ) It seems boring working in a big hospital/clinic in a big city for the entirety of my life, which is more likely to happen in specialty medicine (but the alternatives might be equally boring in different ways, who knows). I also like the idea of getting hands dirty doing procedures (I was bit facetious earlier about the gross-out factor; I’m sure I will get habituated to it).

There’s a downside to everything, but I guess it’s making sense to pay heed to the general suggestion and err on the side of caution for now. But I’m positive (as +ve as I can be) that it will eventually come to a question of FM vs IM anyway.

Also, looking at NRMP data, match rate for FM is 97%, similar to the overall match rate. I guess this number by itself doesn’t convey how easy it is to get into FM, but at the end of the day there are people not matching into FM (and it would be quite competitive getting into the really good ones). Not sure what they end up doing.

 

[Nasrudin]

Combined specialties are for the indecisive and foolish. And very occasionally the academically thirsty.

 

[wlf87]

Yes, I admit I had those thoughts, and then saw posts to that effect -- in the end it's a hassle maintaining dual certifications and people end up doing one or the other for various reasons.

 

[wlf87]

I think I'd probably agree in most cases. Although I'm just saying since the OP is undecided between going to a med school that locks him into FM vs going to a regular med school, then if he goes to a regular med school, then he could still do FM combined with whatever if he truly feels the need to do FM.

 

[jl lin]

I think I'd probably agree in most cases. Although I'm just saying since the OP is undecided between going to a med school that locks him into FM vs going to a regular med school, then if he goes to a regular med school, then he could still do FM combined with whatever if he truly feels the need to do FM.

I would disagree with Nas' comment. If you like peds as well as adults, you are probably going to find significantly less peds than say if you worked as IM/Peds. FM seems fine, but you could get as little as 10% or < pediatrics patients. That's a bit of a bummer for me.

 

[bashwell]

The advantage of FM for me is being able to sort of do it all in a very rural area, and also it would come handy in international underserved settings. But I want to do this only for short stints (to fulfill those "life experiences). And again this may not be as exciting as I'm thinking sitting here, as I read on the MSF website that some FM docs end up coordinatiing basic vaccination/preventive-medicine kind of drives (but it's still very important unsung work)

In an urban area, there are specialists to handle everything an FM does, so I think they would anyway end up doing adult outpt medicine, and they also have an option not to deal with being hospitalist, unlike IM (being told what to do by hospital admins). The downside is not being able to pursue specialty medicine in the future in case they get burnout. Downside to specialty med is being restricted to practicing in hospital settings.

I also don't know what does it do to one's job prospects if one keeps moving around doing different things.

I think there's truth to what you say here, but also (if I can humbly say) some misconceptions. On the one hand, it's genuinely inspiring to read what you write and even the way you write since I'm sure these are some of the reasons many of us went into medicine as innocent, wide-eyed pre-meds as well. But on the other hand, I want to say this as gently and kindly as I can, and please forgive me if I fail, but there's also a lot that may not be able to be entirely understood until you're actually in the trenches, so to speak.

That's another reason why in my opinion it'd best to leave your options open with regard to specialties. I know it's hard though since this FM offer seems so good from where you are. But from where I stand, and having been through what I've been through, it's really not all that great of an offer. But again all this is just my opinion, and I could easily be wrong, and ultimately you know what's best for yourself. Worst case scenario, you'll still be a doctor.

By the way, I think it's really great that you're trying to best figure it all out beforehand before taking the plunge, which is more than I can say for myself, to be honest. And SDN is a good if imperfect resource (though there probably are no perfect resources).

 

[wlf87]

Thank you for your kind and empathetic words. What you say, so elegantly, is indeed very true and comes from experience.

You’ve summed up my predicament very aptly. I wasn’t expecting to be accepted to the FM program, and the adcom has been really nice. Plus it would be a bummer if I do pick FM after all. And since they’re focused on primary care, I’m sure the training will be great. Plus with my age, it might be a good fit. But I will put this decision behind me now. I guess in the bigger scheme of things, it perhaps makes little difference. Or in the words of Yogi Berra, when you come to a fork in the road, take it! And although this is my decision alone, your words are reassuring, so thank you!

SDN is a great resource, thanks to people like you, and I hope to pay it forward one day. I had a couple of months to think this, but here I am trying to make up my mind at the last minute. And if I had really researched well, I honestly don’t think I would have started on this journey.

 

[sazerac]

Thank you for your insight. I thought I had made up my mind, but after seeing what you wrote, it's better I change it. If you don’t mind, what made you change your mind about not doing FM , since you had quite a good idea and you want to go into primary care anyway? I thought FM was more suited than IM for primary care because it trains you more in the outpatient procedures.

What I really like about FM is the variety and flexibility, location-wise and practice-wise, which would make for a “richer life experience.” (I guess that’s what all primary docs would probably label it ) It seems boring working in a big hospital/clinic in a big city for the entirety of my life, which is more likely to happen in specialty medicine (but the alternatives might be equally boring in different ways, who knows). I also like the idea of getting hands dirty doing procedures (I was bit facetious earlier about the gross-out factor; I’m sure I will get habituated to it).

There’s a downside to everything, but I guess it’s making sense to pay heed to the general suggestion and err on the side of caution for now. But I’m positive (as +ve as I can be) that it will eventually come to a question of FM vs IM anyway.

Also, looking at NRMP data, match rate for FM is 97%, similar to the overall match rate. I guess this number by itself doesn’t convey how easy it is to get into FM, but at the end of the day there are people not matching into FM (and it would be quite competitive getting into the really good ones). Not sure what they end up doing.

When I entered medical school I was an unencumbered man with a history of wanderlust and experience in small rural towns. FM made sense.

Now I am married, with several children of my own, to an urban woman with tons of urban support, and on my FM rotation I discovered I really like working with kids (and of course their parents) since I can now relate to them. I much prefer pediatric encounters to adult ones. There is no way I could have known this without the combination of urban FM exposure and having kids of my own, and I picked up both after I started medical school.

Life can change, and change in a lot of unforeseen ways, in three years.

As for matching in FM, a fellow student at my US school got an embarrassing 193 on her step 1. To be safe, she applied to 45 FM programs for the 2014 match, including some reaches at attractive programs in California. She got interviews at 43 programs and had to turn down a lot of them.

 

[wlf87]

Amazing story. Thanks for sharing!.

Also thanks for the FM match anecdote. It's bit reassuring that maybe I'm not taking that big of a risk here. (I guess one has to go through the entirety of the medschool process to fully realize the wisdom of what posters like yourself have been suggesting.)

And congratulations!!


(I'm sure people will pick the more positives than negatives in this thread.)