Current MS4 here who should be working on ERAS right now but instead I'm procrastinating on the forums and I feel I need to at least get this off my chest and see what happens. I've been stuck deciding between radiology and anesthesiology for a very long time and time is pretty much up now. I really like both specialties and identified my interest in both pretty early on but I geared myself towards radiology for of a few reasons: 1) IR 2) I spoke to the specialty advisor at my school who is a Pain doc from anesthesiology and he advised me to explore other options. Told me he liked being in the OR and hated clinic... but yet went into pain and hated his clinic patients although I'm sure he did very well in his career. Also told me it can get boring after a while. Said b/c I have a good Step 1 score (~<250) I could match into something "better" 3) Lots of doom and gloom here and other forums scared me away.. being honest Taking those things into consideration, I ditched anesthesia and set up a few IR and DR electives for fourth year and now that I've done them I've realized a couple of things. IR can be pretty great but depending on the setting it may or may not be so amazing. While I was rotating through academic centers there were lots of really innovative procedures that we were doing that I really enjoyed but now that I'm in a community hospital, not so much. I'm seeing a lot of biopsies, drains, and port placements and not much else. Even the trauma cases we saw in IR were a little anticlimactic. There's also something a lot less "tactile" about it than I originally imagined. I'll use a case we did as an example of that... trying to thread the wire past some large renal calculi into the ureter to place a stent under fluoro and the only thing you can do is pull the wire back, rotate it a little, and push forward and hope it moves forward this time... for 3 hours just looking at the screen and fiddling with the wire. I know most cases aren't like that but when you're scrubbed in as a med student looking over the attending's shoulder for a few hours you have some time to contemplate how much you really want to be in their place. On the other hand I found DR more interesting than I anticipated and I think it's something that you get to enjoy more with more knowledge you have. All of the residents/attendings I encountered seemed to like what they were doing and that was very encouraging. With that being said, I don't have a natural interest in reading images and dictating tons of incidental pulmonary nodules on a chest CT while the PACS list continues to grow is anxiety inducing. I know things can change and the more I learn about what to look for in imaging the more interested I become but it's still hard for me to envision dictating reads for my entire career at this point. Also, many radiology residents I spoke with originally went into radiology for IR but decided against it after seeing how much they work. To me, DR seemed mentally exhausting even though the hours are good. The volume and speed those guys have to work at is amazing. Now I'm having a hard time seeing myself doing either. To top it off, IR has its own pathway now and is insanely competitive to get into directly. ESIR programs are probably my best bet but there isn't any guarantee because the entire fellowship structure is changing. Radiology pretty much requires a fellowship regardless so that means 6 years of post-grad training no matter what, possibly 7 for IR worst case scenario. Anesthesiology, in my eyes, seems like a lot of what I came into medicine for. Insulated away from a lot of the social stuff that IM/EM gets and dealing only with sick patients or patients that need to have something done. Short but rewarding interactions with patients before undergoing a life-changing events. It's not always intense when things are running smoothly but when things do go wrong you are the last line of defense and have to act under pressure. You are an expert at keeping people alive and life support. I enjoy the physiology of anesthesiology more than I enjoy the anatomy in radiology. I also like the neurological component of it referring to regional blocks and pain. Lots of variety of patients and procedures and there also seem to be good fellowship options after residency to expand your practice setting outside of the OR into the ICU or clinic. I like the OR environment and there seems to be great personalities in anesthesia that I match well with. Anesthesiology honestly looks like a lot of fun to me and could lead to a good job with a lot of options and flexibility. A little more about me if it helps paint the picture. I have always considered myself more of a do-er vs a talker. Grew up building things with my dad, playing team sports, and working on car engines and stereos. I like acute care and seeing immediate results. Treating patients long term never really interested me. Consider myself to be very laid back but also think I work well under pressure. Changed careers so I'm non-traditional and go to a non-top tier med school. Good Step 1 score and even mix of H/HP 3rd year grades. Some research but not much and not in either anesthesiology or radiology. From the west coast and would like to move back for family/friends. I'll end it here before this gets any longer but any guidance is much appreciated.