angst regarding choosing a specialty

[daisygirl]

Are there any other third years having trouble deciding what to do with their lives when they grow up?

I'm having a really tough time deciding on pursuing surgery with the intentions of going onto a vascular fellowship or choosing medicine with the intention of going onto cardiology. I have to make up my mind in the next two days and change my fourth year schedule accordingly- if I wait any longer I'll be forced into one or the other since there isn't much leeway to change my schedule around due to the limited number of spots in fourth year clerkships at my school.

Is anyone else suffering like me right now

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[johnny_blaze]

I’m pretty much in the same position as you. I’m a third year with intentions of going into vascular surgery. However, I am also considering hepatobiliary, thoracic, and Trauma/critical care as other surgical options. There are aspects of each that I find appealing. I also have an interest in EM so I haven’t 100% dedicated myself to surgery.

I guess the best thing to do is to take life as it comes and make the decisions when they need to be made. Trust your judgment… if you think too much about the future you’ll miss out on what the present has to offer.

I’m doing my elective soon in vascular surgery but after that I may still decide to go into something else if I’m not greatly impressed. I didn’t even really plan on going to medical school… it just sort of happened because deep down inside I guess I just really wanted it.

I dunno if this helps or not… its just my 2 cents. holla

 

[fourthyearmed]

What you need to decide is how much do you love the OR? If you absolutely love every minute of it and can't imagine not being there, choose Vascular. If you're just so-so about the OR choose Cards is my suggestion.

 

[daisygirl]

What you need to decide is how much do you love the OR? If you absolutely love every minute of it and can't imagine not being there, choose Vascular. If you're just so-so about the OR choose Cards is my suggestion.

I love the OR. I had such a great time in vascular- I honestly never cared how long a case went on for (and some went on and on and on ). However, I love cardio equally. I do believe that I will ultimately miss the OR if I don't pursue surgery. Alternatively, I may find that I am just as happy with cardio since I most likely would go for an interventional fellowhip.

Ultimately, I believe that I'll make my choice based on 'lifestyle'. Both paths are pretty grueling in terms of training and lifestyle once training is completed, however, cardio seems to allow for a better life after training. In all honesty, I'm afraid that my marriage won't survive a 'surgeon's life'.

Thanks for all opinions thus far

 

[ears]

I understand the angst, and I sympathize.

However, you might take comfort from the fact that it sounds like you've narrowed things down to two fields that would both make you pretty happy. That's a great situation---you win either way.

It sounds like you're torn about whether you love the OR enough to pay the price in terms of lifestyle. You're comparing it to interventional cards, so it might not be that huge a difference anyway.

Further complicating the lifestyle issue, you could probably craft either one to suit yourself better once you were done with training.

Bottom line: heads, you win; tails, you also win.

 

[tubbs]

i feel the same way. surgery is interesting, but there's a lot of other exciting fields we can go into. i can see myself enjoying several different careers, but i surely don't want to sacrifice my family for it. most of my close friends, wanted to go into surgery at the start of med school. you could have bet your house that they were going to be surgeons. but as time past...i don't know, maybe they wised up, matured, began to think more practically, etc and ended up applying only for lifestyle friendly specialties like rads, anaesthesia, EM, ophtho, etc. i totally agree with them that family comes first. and if you don't have a solid family, i don't care what you do, you're not going to enjoy it. maybe that's why there's so many other people thinking the same thing and pursuing other more lifestyle friendly, yet still interesting specialties.

 

[doc05]

Further complicating the lifestyle issue, you could probably craft either one to suit yourself better once you were done with training.

that's true, at least somewhat. nonetheless, neither vascular surgery nor cardiology is, or will ever be, a "lifestyle-friendly" field.

 

[cchoukal]

This has always been a really tough, lonely decision. Take comfort that both fields will provide challenge, reward, and decent money. One thing to consider is that if you're the type of person who is that serious about surgery, but end up choosing cardiology, you'll probably find yourself in an interventional fellowship after cards fellowship, which means you'll be looking at 8 years of training (9 if you do a chief year). This isn't much less than gen surg plus a vascular fellowship. Ultimately, at least in my limited experience as a recently graduated 4th year, the interventional cards guys came across as more of a technician, whereas the vascualr surgeons seemed to take more interest in their patients care. This is probably highly variable.

On the other hand, consider the future of vascular surgery. I'm sure people have argued about this in other forums, but it seems like a lot of vascular procedures are being approached endovascularly by non-surgeons (AAAs, now carotids, and I've seen some peripheral procedures done this way as well).

Plenty can happen between now and when you finish a gen surg residency, so I guess i'd reiterate my first point: worry less about whether you'll do a vascular fellowship or whatever, but recognize that if you're a surgery-type, you'll likely spend a lot of years in cardiology trying to be a sort of pretend surgeon, when for about the same amount of time, you could become an actual surgeon, and choose a subspecialty once you've had more exposure to the areas.

 

[MD Dreams]

They are both fantastic fields. Both have a lot in common. Both are very demanding. I think the thing you need to ask yourself is whether you like internal medicine. To get to cardiology you have to go through 3 years of internal medicine. In addition, the non-interventional aspect of cardiology, which you will still have to know and practice to some degree, is very similar to IM. Therefore, if you don't like being a primary care physician (which you will be for cards pts.), taking care of chronic illnesses, and all the other stuff that defines the medical aspect of medicine, then stay away from cards. For me, I don't have the patients nor the desire to pursue the medical side of medicine so cards (interventional or not) would be out of the question. I love taking care of pts., but I want to get to the problem, fix it, and move one, so I would choose vascular surgery, plus I love the OR. Whichever route you choose, I think you need to realize that these are both very demanding specialties, life-style will come second to your profession. Good luck.

 

[14022]

I don't think the urgency of your decision is as severe as you think. If I were you, I would do a medicine subinternship, which will help you for either a career in surgery or internal medicine. Vascular surgery seems to be a a very medically-oriented field since many of the risk factors for vascular disease are medically managed. You really do not have to decide until October when you start applying for residency. Neither medicine nor surgery are an early match. If you do an entire year of surgery and then choose to go into medicine, so what? Fourth year can be looked at in two different ways; (1) preparing for your future by taking electives in your desired field; or (2) taking electives in which you will never see again for the rest of your life.

Remember, both cardiology and vascular surgery are fellowships, so that decision does not have to be made until a year into residency. Your main issue is internal medicine vs general surgery. Neither are terribly competitive so it isn't like either field is not going to interview you because you didn't spend all of fourth year taking electives specific to that field. I would think that internal medicine would be more forgiving regarding a year of surgical electives versus than surgery would be of a year of medicine electives. Since it is up in the air, take a month of vascular surgery, a month or two of cardiology electives (consult for a month, echo for a month, etc.) and then take electives that will serve you well in either field. Surgical ICU and Cardiac ICU would help in each. A month of interventional cardiology, interventional radiology, or vascular lab would help you for both since catheterization is common to both fields. And finally take a month or two in something unrelated that you are also interested in.

And to speed up the process, you could start now on your personal statement. Make one for each specialty. Not only will it save time later, but by looking at each specialty in a systematic manner, it may help give you perspective on your interest in each field that you may not have otherwise had. It may be difficult to obtain letters of rec but you may want to ask one or two people in each field and then if it turns out you don't need them later, dont send them to programs. From my understanding you can upload several letters into ERAS and can choose which three letters will be sent to each individual program to which you will apply.

Also, if it comes down to it, if you spend your intern year in one of the fields and decide it is the wrong decision, you can always reapply into the other field. The year experience in the other field will serve you well. And even if the experience was a complete waste of time for you, you only wasted one year of your life which is nothing if you consider the many years of additional happiness that you will have upon switching fields.

So relax, enjoy your fourth year, which is the greatest year of your academic career. Gain exposure to both fields and reevaluate your career goals in a few months from now when it is time to apply.

 

[cchoukal]

wow, scholes, that was just really, really, all-around excellent advice. I think the topic should close with that.

 

[Goose...Fraba]

I love the OR. I had such a great time in vascular- I honestly never cared how long a case went on for (and some went on and on and on ). However, I love cardio equally. I do believe that I will ultimately miss the OR if I don't pursue surgery. Alternatively, I may find that I am just as happy with cardio since I most likely would go for an interventional fellowhip.

Ultimately, I believe that I'll make my choice based on 'lifestyle'. Both paths are pretty grueling in terms of training and lifestyle once training is completed, however, cardio seems to allow for a better life after training. In all honesty, I'm afraid that my marriage won't survive a 'surgeon's life'.

Thanks for all opinions thus far

Choosing between cardio and vascular surgery and you think that one offers a better lifestyle?!!!! That has to be the funniest freakin thing Ive heard my whole life! Gosh you need to really need to rethink, if you are deluded into thinking one or the other offers a "better lifestyle". Thanks though I needed a good laugh

 

[daisygirl]

Thanks for all of your opinions Ultimately, I've decided to go with surgery since I'd miss the OR too much. I've got a tough road ahead of me, but it'll be worth it in the end

 

[daisygirl]

Choosing between cardio and vascular surgery and you think that one offers a better lifestyle?!!!! That has to be the funniest freakin thing Ive heard my whole life! Gosh you need to really need to rethink, if you are deluded into thinking one or the other offers a "better lifestyle". Thanks though I needed a good laugh

I do understand that cardio is not a lifestyle field per se, however the lifestyle in cards is better than that of a vascular surgeon. I've worked with a few cardiologists (interventional and non-int.), and their hours were far better than the vascular surgeons that I've worked with.