Specialty Help Vascular vs IM (Pulm-CC)

[TheRealDirtyDan]

I know, I know, this is one of "those threads" but I have to tentatively choose a specialty before the start of next semester and covid made that nearly impossible

So far I've narrowed it down to IM-Pulm/CC vs vascular surgery . Unfortunately, my ICU rotation and part of my surgery rotation were online so I didn't get the full experience of either.

I love high acuity situations where I get to be in control. I loved being in the OR getting to work with my hands and develop a skill. I also loved hospital work far more than clinic (I hated clinic so much).

VS
Pros: shorter residency, good job security, high pay, ability to transition to cosmetics/veins later in career, I want to be a surgeon
Cons: surgery residency sounds like hell, I would ideally like to not die alone, honestly not sure if I have the health to endure that residency

IM-Pulm/CC
Pros: Better lifestyle during residency (and probably as an attending) , shift work, no call, ability to transition to pulm outpatient
Cons: Longer residency, I HATED endless rounding and typing for 6 hours day, lot of nights and weekends, not sure I'd want to go through 3 years of IM


Decent scores and research to do about anything except Plastics/ENT

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[slowthai]

Vascular. You seem to have a passion for surgery. The cons for the IM subspecialty are too strong for IM to win out. Plus you can always switch to IM if you find a surgical residency to be too much. Can't do it the other way around (or, it'll be way harder at least)

Also, assuming you'll be gunning for I-5, that's just one year less than pulm/CC. If you end up going the GS + fellowship route for vascular, that'll actually be 7 years, so I don't think that's a good deciding factor.

 

[group_theory]

I love high acuity situations where I get to be in control. I loved being in the OR getting to work with my hands and develop a skill. I also loved hospital work far more than clinic (I hated clinic so much).

Do Trauma-Acute Care Fellowship after General Surgery

 

[Neopolymath]

The easy way I ruled out all IM-based specialties super quickly, aside from hating IM, was the worst case scenario: You endure 3 years of IM (maybe 4 for chief year lol) and don't match GI or whatever and then are an IM doc forever. Pulm-CC, GI, Heme-Onc are dope but I'm too risk averse with regards to the uphill battle as a DO for that nonsense. Thank god that we have so many people who do the important work in primary care and IM wards because I definitely could not do it as a career. It takes all kinds to make the system work.

The worst case scenario of not matching into GS-based fellowship is being a general surgeon and the many avenues that can take you in the OR. In the community these guys aren't doing just appys, choles, and inguinal hernias. They do so much more. If you truly love surgery then even if you fail to achieve the subspecialty you want you will still enjoy your career as "just" a general surgeon. It does not sound like you can say the same for an IM based path.

 

[AnatomyGrey12]

Surgery. I agree with the Trauma/ACS fellowship idea, if you're looking for intense situations but the ability to perhaps have a shift work type schedule then trauma could fit all of that.

 

[TheRealDirtyDan]

Surgery. I agree with the Trauma/ACS fellowship idea, if you're looking for intense situations but the ability to perhaps have a shift work type schedule then trauma could fit all of that.

Thank you all for your answers. I will go with my gut and choose surgery. I truly dislike clinic. If the lifestyle is too much I think I'd be able to switch out.

 

[Drrrrrr. Celty]

Don't do Pulm/CC if you don't like IM. It's literally medicine on steroids with intermittent procedures. It's also honestly a specialty where you have to have a lot of respect for being flexible about not having control. While it's certainly not the mental masturbation field like some of the other IM fields, probably the smartest folks in medicine go into it.

 

[Drrrrrr. Celty]

The easy way I ruled out all IM-based specialties super quickly, aside from hating IM, was the worst case scenario: You endure 3 years of IM (maybe 4 for chief year lol) and don't match GI or whatever and then are an IM doc forever. Pulm-CC, GI, Heme-Onc are dope but I'm too risk averse with regards to the uphill battle as a DO for that nonsense. Thank god that we have so many people who do the important work in primary care and IM wards because I definitely could not do it as a career. It takes all kinds to make the system work.

The worst case scenario of not matching into GS-based fellowship is being a general surgeon and the many avenues that can take you in the OR. In the community these guys aren't doing just appys, choles, and inguinal hernias. They do so much more. If you truly love surgery then even if you fail to achieve the subspecialty you want you will still enjoy your career as "just" a general surgeon. It does not sound like you can say the same for an IM based path.

I'm not sure that's a sound reason to avoid IM. If you really want a fellowship then you do what you need to do to make it happen. It's not like the 4th year of medical school. Some folks do hepatology fellowships to match into GI. Others do research years to match into hem/onc. Others just go to a residency with a fellowship and make their stake.

It's about choosing the life you want to have and the field you want to be in for the rest of your life. No one is forcing you to be a hospitalist.

 

[Drrrrrr. Celty]

Thank you all for your answers. I will go with my gut and choose surgery. I truly dislike clinic. If the lifestyle is too much I think I'd be able to switch out.

I agree. Surgery for the right person is a great place to be. If you don't find you like it, you can move into a different field. It's not unusual.

 

[_DeBakey_]

If you go IVS I don't think(???) you can do trauma call w/o the GS certification (someone please correct me if I'm wrong)

BUT...

You will be called in to cases that need help with bleeding

 

[TheRealDirtyDan]

I'm not sure that's a sound reason to avoid IM. If you really want a fellowship then you do what you need to do to make it happen. It's not like the 4th year of medical school. Some folks do hepatology fellowships to match into GI. Others do research years to match into hem/onc. Others just go to a residency with a fellowship and make their stake.

It's about choosing the life you want to have and the field you want to be in for the rest of your life. No one is forcing you to be a hospitalist.

A big reason why I didn't lean towards other specialties is because I didn't want to have to "grind" for fellowship. With VS, it's a one done deal - 5 years then I'm out. Rather than having to worry about matching into a fellowship like IM.

 

[Mbeas]

Do Trauma-Acute Care Fellowship after General Surgery

Agree with this. Sounds like you are better off going the surgical route, but based on your initial post, why vascular surgery? "short residency, high pay, I want to be a surgeon" is not a great personal statement when you apply. You need to have a solid reason for pursuing vascular. If you are still considering specialties, general surgery may be a good for you to give you time to weigh your options.

 

[AnatomyGrey12]

Agree with this. Sounds like you are better off going the surgical route, but based on your initial post, why vascular surgery? "short residency, high pay, I want to be a surgeon" is not a great personal statement when you apply. You need to have a solid reason for pursuing vascular. If you are still considering specialties, general surgery may be a good for you to give you time to weigh your options.

This was kind of my thinking OP. I see the reasons to do surgery, but don’t really see a well thought out reasoning for vascular specifically.

 

[TheRealDirtyDan]

This was kind of my thinking OP. I see the reasons to do surgery, but don’t really see a well thought out reasoning for vascular specifically.

So I really like the breadth of vascular. There are long extensive open surgeries with high acuity. But there are also fast endo procedures that are on the cutting on edge of surgery. I get to operate across the entire body and have a diverse array of cases.

I also really enjoy the longitudinal aspect where I can build a good relationship with my patients over many years. Also having the option to be connected with cosmetics seems lucrative.

Also a lot of my research in med school deals with wounds/revascularization.

 

[Drrrrrr. Celty]

A big reason why I didn't lean towards other specialties is because I didn't want to have to "grind" for fellowship. With VS, it's a one done deal - 5 years then I'm out. Rather than having to worry about matching into a fellowship like IM.

Which is fair. I think there's a bit of disconnect in this perspective however. Cardio, Pulm/CC, and GI are specialties you're going to need to grind to match. If you're grinding then chances are you wanted to do them more than you wanted other things. However if you're looking at all the options you could have after IM then you'll find that there are an like 10 other specialties that you could choose many of which aren't very competitive or moderately competitive.

This not counting that even at a hard IM program the rotations and the grinding isn't really as hard as the average week of surgery is though. Clinic weeks and chill rotations like consults are 40-50 hour work weeks. Like even a bad call weekend for me is probably what an average week is like for a gen surgery resident and I've never broken 100 hours of work like some of my gen surgery friends have.

 

[BorntobeDO?]

Don't do Pulm/CC if you don't like IM. It's literally medicine on steroids with intermittent procedures. It's also honestly a specialty where you have to have a lot of respect for being flexible about not having control. While it's certainly not the mental masturbation field like some of the other IM fields, probably the smartest folks in medicine go into it.

I liked this comment till the last line. The smartest folk in medicine go into derm not medicine. Then GI right after that.