I am almost an M4 and have no idea what I want to do with my life. I have really enjoyed almost every rotation in med school and have not even decided surgery vs medicine, so I'm hoping someone can offer some insight 🙂 Sorry for the wall of text
On surgery, I loved how time flew by so quickly in the OR, and how I and the residents got better at various things (me with closing the incision or doing simple tasks, residents with the actual cases) every day or every time we did it. I have shadowed considerably in several surgical specialties (general surgery, urology, gyn/gyn-onc, ophtho, ENT, neurosurg, ortho) and I liked them all about the same, so I would ultimately choose based on the people in the various fields (I got along with residents/attendings in some better than others). The OR atmosphere is also great: a whole team focused on one goal without too much paperwork or BS getting in the way, you get to teach/learn one-on-one and you are the captain of the team. However, even though I think I would enjoy surgical residency a lot due to the variety of doing different things with different attendings and getting better each time, I am worried that in a surgical specialty I will eventually just do 4-10 operations over and over again. I want to do academics and the reality of academic practice is that you end up that specialized one way or another (usually you get sorta good at one thing, get referred for that one thing, so you get better and better and before you know it you're the expert). They will probably still be somewhat fun as attendings always say but it does not feel like career growth to me--and eventually, if I want to switch and start doing different operations, it may feel like a career step back since I will go from being the best at a few operations that I did to being mediocre at a few new operations that I started doing. I do not see myself as a 50-year old surgeon saying "I'm bored with the operations I rock at so let me start doing a crappy job at something else so it will be more fun." With all this in mind, I usually hear from people that you just have to "survive" surgery residency and then life is great as an attending, which is the opposite of how I feel right now, so I don't know if this concern is a valid one.
On the other hand, I loved medicine. I thought about my patients, thought about the diseases, couldn't wait to share the interesting stuff I saw/thought about/learned with my classmates when I saw them in the halls of the hospital ("I just saw a patient with anti-GBM disease who presented with a cough, now on plasmapharesis, and we're trying to manage his lung disease, kidney disease, and possible underlying liver disease while he gets through this"). I never felt as excited about "cool" surgical things. I liked that medical patients had multiple interacting problems so that on every list there were at least a few patients that the attendings had to scratch their heads over, despite years and years of experience ("Do we stop drug X if it MIGHT be inducing autoimmunity against multiple organs, including the cardiac conduction system, even if drug X is critical for his cardiac function?"). One caveat is that most of my exposure has been in the in-patient setting, whereas I will likely practice as an outpatient specialist in the long run. I was in 2 weeks of cardiology and 1 week of heme/onc clinic, which did not have as many challenging cases as in-patient medicine (a lot of "looks like your cardiac regimen is good and you feel good, see you in 6 months" or "the tumor looks like it is growing so we will start you on the standard chemo regimen"), but there were still 2-4 challenging decisions per day that required serious thought about pathophysiology and/or discussion with your colleague next door like the drug X example from my in-patient experience (these are the discussions I LOVE to have). The other nice thing is that cardiology and heme/onc change faster than surgery, so there are always new papers/drugs/recommendations that come out, and the specialist has to re-consider their patients in the new light to see if they qualify for different treatment (or even if they don't strictly qualify by the trial criteria, do you think the new drug will work for them based on your clinical expertise?). Cardiology and heme/onc are nothing like what they were 30 years ago, while surgery, aside from laparoscopy in the abdomen/pelvis, has not fundamentally changed very much--cataracts, prostates, tongue tumors, aortic valves, and knees are all taken out/replaced in pretty much the same way as always.
Some people have said to me that there are some specialties that "mix" medicine and surgery like ophtho, ENT, and urology, but while those fields all do have medical management options for their patients, the approach, thought process, and pathophysiology is not as medically interesting as the medical specialties. All of these specialties are at their heart surgical subspecialties dealing primarily with surgical or anatomic problems. There are few advances in the fields and little complicated medical decision making, other than whether or not it is worth it to take a very sick patient to surgery in order to possibly improve their lives, which is present in ENT and urology to some extent. Therefore, even though I really enjoyed all three of them, they do not address the dilemma between surgery and medicine for me. I have also considered radiation oncology, where I'm told you "think like a medical doctor, but treat like a surgeon," but only have a little exposure so far, and no elective until later in the fall this year. I considered derm since it is also sort of medical and procedural, but did not enjoy the lack of "real" problems. I have thought about GI and interventional cards. I lumped GI in with surgery since the procedures are cool but the clinic/diseases are not as complex or interesting as the cards and heme/onc stuff I saw. I will not do interventional cards for lifestyle reasons (cannot do Q5 STEMI call when I have a family).
I have already done an advanced surgical subspecialty elective and it just confirmed what the 4 months of surgical stuff I did during the rest of M3 told me, so it did not really help. I have a medicine sub-I late in the fall, but expect to love it just like I loved the 3 month medicine clerkship. Does anyone on SDN have any advice? I am desperate.
TL;DR: Surgery is super fun to do and I love the OR but I'm worried it will get old. Medicine clinic can get boring but there occasional REALLY more interesting things to talk/think about and the fields are more rapidly evolving which keeps it fun.
On surgery, I loved how time flew by so quickly in the OR, and how I and the residents got better at various things (me with closing the incision or doing simple tasks, residents with the actual cases) every day or every time we did it. I have shadowed considerably in several surgical specialties (general surgery, urology, gyn/gyn-onc, ophtho, ENT, neurosurg, ortho) and I liked them all about the same, so I would ultimately choose based on the people in the various fields (I got along with residents/attendings in some better than others). The OR atmosphere is also great: a whole team focused on one goal without too much paperwork or BS getting in the way, you get to teach/learn one-on-one and you are the captain of the team. However, even though I think I would enjoy surgical residency a lot due to the variety of doing different things with different attendings and getting better each time, I am worried that in a surgical specialty I will eventually just do 4-10 operations over and over again. I want to do academics and the reality of academic practice is that you end up that specialized one way or another (usually you get sorta good at one thing, get referred for that one thing, so you get better and better and before you know it you're the expert). They will probably still be somewhat fun as attendings always say but it does not feel like career growth to me--and eventually, if I want to switch and start doing different operations, it may feel like a career step back since I will go from being the best at a few operations that I did to being mediocre at a few new operations that I started doing. I do not see myself as a 50-year old surgeon saying "I'm bored with the operations I rock at so let me start doing a crappy job at something else so it will be more fun." With all this in mind, I usually hear from people that you just have to "survive" surgery residency and then life is great as an attending, which is the opposite of how I feel right now, so I don't know if this concern is a valid one.
On the other hand, I loved medicine. I thought about my patients, thought about the diseases, couldn't wait to share the interesting stuff I saw/thought about/learned with my classmates when I saw them in the halls of the hospital ("I just saw a patient with anti-GBM disease who presented with a cough, now on plasmapharesis, and we're trying to manage his lung disease, kidney disease, and possible underlying liver disease while he gets through this"). I never felt as excited about "cool" surgical things. I liked that medical patients had multiple interacting problems so that on every list there were at least a few patients that the attendings had to scratch their heads over, despite years and years of experience ("Do we stop drug X if it MIGHT be inducing autoimmunity against multiple organs, including the cardiac conduction system, even if drug X is critical for his cardiac function?"). One caveat is that most of my exposure has been in the in-patient setting, whereas I will likely practice as an outpatient specialist in the long run. I was in 2 weeks of cardiology and 1 week of heme/onc clinic, which did not have as many challenging cases as in-patient medicine (a lot of "looks like your cardiac regimen is good and you feel good, see you in 6 months" or "the tumor looks like it is growing so we will start you on the standard chemo regimen"), but there were still 2-4 challenging decisions per day that required serious thought about pathophysiology and/or discussion with your colleague next door like the drug X example from my in-patient experience (these are the discussions I LOVE to have). The other nice thing is that cardiology and heme/onc change faster than surgery, so there are always new papers/drugs/recommendations that come out, and the specialist has to re-consider their patients in the new light to see if they qualify for different treatment (or even if they don't strictly qualify by the trial criteria, do you think the new drug will work for them based on your clinical expertise?). Cardiology and heme/onc are nothing like what they were 30 years ago, while surgery, aside from laparoscopy in the abdomen/pelvis, has not fundamentally changed very much--cataracts, prostates, tongue tumors, aortic valves, and knees are all taken out/replaced in pretty much the same way as always.
Some people have said to me that there are some specialties that "mix" medicine and surgery like ophtho, ENT, and urology, but while those fields all do have medical management options for their patients, the approach, thought process, and pathophysiology is not as medically interesting as the medical specialties. All of these specialties are at their heart surgical subspecialties dealing primarily with surgical or anatomic problems. There are few advances in the fields and little complicated medical decision making, other than whether or not it is worth it to take a very sick patient to surgery in order to possibly improve their lives, which is present in ENT and urology to some extent. Therefore, even though I really enjoyed all three of them, they do not address the dilemma between surgery and medicine for me. I have also considered radiation oncology, where I'm told you "think like a medical doctor, but treat like a surgeon," but only have a little exposure so far, and no elective until later in the fall this year. I considered derm since it is also sort of medical and procedural, but did not enjoy the lack of "real" problems. I have thought about GI and interventional cards. I lumped GI in with surgery since the procedures are cool but the clinic/diseases are not as complex or interesting as the cards and heme/onc stuff I saw. I will not do interventional cards for lifestyle reasons (cannot do Q5 STEMI call when I have a family).
I have already done an advanced surgical subspecialty elective and it just confirmed what the 4 months of surgical stuff I did during the rest of M3 told me, so it did not really help. I have a medicine sub-I late in the fall, but expect to love it just like I loved the 3 month medicine clerkship. Does anyone on SDN have any advice? I am desperate.
TL;DR: Surgery is super fun to do and I love the OR but I'm worried it will get old. Medicine clinic can get boring but there occasional REALLY more interesting things to talk/think about and the fields are more rapidly evolving which keeps it fun.
Last edited:
