another dude with trouble picking a field

[gman33]

So I'm a few weeks into my fourth year and I still haven't made up my mind about what field I'm going to enter.

I know a lot of people are in this boat, but the more I think about it the more I become indecisive.

EM

I'm currently doing a rotation in EM, which is one of my top contenders.Overall I have liked the rotation. Good variety, interesting cases. A lot of non-emergent stuff, and even some things that are more serious, get kind of routine after you do a few of them. I think it would be a nice fit for me based on the work alone.

The main thing I've been struggling with is the schedule. I'm a good bit older than most of my classmates. The whole day/night switching stuff is a bit of a grind. I can deal with it in the short-term. Not sure about doing it for30 years.

ANESTHESIOLOGY

Haven't done a full rotation yet. Doing it next block.
Did spend about 8 days with gas during my surgery rotation.

Like physio/pharm. Favorite subjects in the first 2 years.
Like the procedures. Like seeing immediate results from interventions duringthe cases.

Like EM, there is a big shiftwork component.

Not sure if Gas is better or worse in this regard.
Probably less "crazy hours", but a bunch more hours overall.
Less time to recover from off hour shifts. (I guess, job dependent).

Psych

Going into third year, this was probably my top choice.
Did some shadowing years 1/2, found it cool.
Liked learning about the psychopath in second year.

Got into my inpatient rotation and found I really didn't like the patients.
Dealing with an endless parade of schizophrenics just wore me down.
Even though they all had different stories, the treatment was basically the same. Pick an anti-psych med seemingly at random and hope for the best.

Keep them around for a week and then boot them out regardless of whether they got better or not.
This is a great exaggeration, but it seems like that was what was going on.

I did have a good time on the rotation, but that was mainly because I reallyliked all the people I worked with.
I did like working with the depression patients and some of the other stuff. But really wasn't too down with the inpatient environment.

Now you're probably saying, just cross this field off your list.
Which is what I pretty much did.

Thing is, I probably would see myself practicing outpatient psych where most of the patients would be depression, anxiety, that kind of stuff.
I think I would enjoy that, and probably be pretty damn good at treating those people.

Nice lifestyle after residency.

If I'm even thinking this now, I need to switch up my schedule and get in another rotation pronto. Can't pull the trigger on this one without another rotation.

Everything else

Surgery -never really considered it. Just not my thing

Medicine -liked the rotation. Don't want to do inpatient. couldn't see myself doing primary care. Don't want to spend forever in training doing a fellowship.

PM&R - didn't do a rotation yet. Like exercise, biomechanics, that kind of stuff. Nice lifestyle. Pretty regular hours after residency. Probably mainly thinking aboutit to get out of working nights in my career.

Bottom Line
I need to figure out how much I want/need to avoid the crazy hours that come with some of these fields. That's not the only thing, but it's a big part of my tihnking right now. I have no trouble working hard, but I just don't function all that well when my sleep patterns are constantly getting screwed.
Also, it's kind of a bummer having off when my spouse is working.

Fire away with any input.
Thanks.

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[deleted263296]

Think more about what your long term practice goals are. For me, I'd prefer to do something that allows me to work anywhere without a patient base such as EM, anesthesiology, or radiology.

 

[shaggy alfresco]

Many people (in the Anes forum and EM forums) list as a con about EM or Anes is that you're 'easily replaceable...eg, take one out and insert another', but a pro to that is that it is easier to move if you want or need to. If you have your own patient base, it's a huge pain and a tremendous expense to simply start from scratch somewhere else and build up that base. So there is a plus and a minus to that component of it.

I never ever ever thought much about Psych (it didn't seem at ALL like my personality) but the more I read about it, the more interesting it seems (from my very limited pov).

 

[gman33]

It's nice to be able to just walk in to a job without start up issues.
Chances are, I probably won't move around much in my life.
Not so sure about psych, but it most things in my area there is such a wait for doc appointments that if you joined a group practice, the start up probably wouldn't be too bad.

I don't think I'd ever want to start a solo practice.

 

[Depakote]

Anesthesia and EM are pretty similar in a lot of respects. You have varying degrees of monotony and occasionally the **** unexpectedly hits the fan requiring a well thought out measured response. Both have procedures.

You'll find a variety of practice models, but I would say ER is probably the more "shift work" job. Anesthesia tends to have good relief schedules, but many models include some element of call.

Personally, I would revisit this decision after you've done your anesthesia rotation next block. It's a lot easier to grasp the scope of the field when you're doing a dedicated rotation. My advice would be to be proactive, though. A lot of the decision making and interventions can be subtle. Ask "why?" and you'll learn a lot and have a much better time.

 

[TexasPhysician]

EM can have a very controllable schedule after residency depending on where you work. Same with Anesthesia. Both are great fields. Go with what you enjoy more after both rotations are over.

 

[DrVanNostran]

gman I had the same problem as (I still may...). I just had to sit down long and hard and think what would I love to 20 years from now...and I thought it about in a one week model. I ended up deciding that I should apply to IM because after 6 years of residency/fellowship I should be able to return home to Chicago work 7/8-5/6 M-F, with call 1:5, one weekend a month within a larger multi-specialty group, which seems to be the major model of the future.

EM is awesome, but 20 years from now, I see myself exhausted.
Gas--I really seem to like it, but I wanted more of an outpatient experience 20 years from now.
Psych-great lifestyle, very controllable, if you can see yourself doing it 20 years from now, it's an awesome field.

I don't know if salary, etc is a concern. I know we don't know much about the future, but right now it seems that Gas>EM>Psych in terms of salary. But psych could generate enormous revenues within the right system.

 

[Doctor4Life1769]

gman I had the same problem as (I still may...). I just had to sit down long and hard and think what would I love to 20 years from now...and I thought it about in a one week model. I ended up deciding that I should apply to IM because after 6 years of residency/fellowship I should be able to return home to Chicago work 7/8-5/6 M-F, with call 1:5, one weekend a month within a larger multi-specialty group, which seems to be the major model of the future.

EM is awesome, but 20 years from now, I see myself exhausted.
Gas--I really seem to like it, but I wanted more of an outpatient experience 20 years from now.
Psych-great lifestyle, very controllable, if you can see yourself doing it 20 years from now, it's an awesome field.

I don't know if salary, etc is a concern. I know we don't know much about the future, but right now it seems that Gas>EM>Psych in terms of salary. But psych could generate enormous revenues within the right system.

Just to throw this out there. You could do a year of interventional pain fellowship and open up shop. You could also do locum, too.

Either way, IM is a good field too.

 

[jdh71]

Just to throw this out there. You could do a year of interventional pain fellowship and open up shop. You could also do locum, too.

Either way, IM is a good field too.

I think in the future only fellowship trained IM guys will be in the "good field" category.

While the hospitalist gig is certainly nice right now, as AMGs begin to fill american IM spots with the increase in the class sizes coming out of medical schools, this will make fellowship more competitive - because . . . common, AMGs don't want to work in primary care - which mean more people doing hospitalist work because they couldn't find a fellowship spot, on top of the people who want to do hospitalist because they don't want to do fellowship or work in the out-patient setting AND with more and more FPs also filling that role because even they simply can't abide out-patient primary care as it currently is, you'll quickly find the hospitalist market very saturated in 5 to 10 years. I hope I don't have to give an economics lesson on that one MD levels minds posting in here what that will mean for number positions, bargaining leverage, and ability to live in "desirable locations".

 

[PMPMD]

So I'm a few weeks into my fourth year and I still haven't made up my mind about what field I'm going to enter.

I know a lot of people are in this boat, but the more I think about it the more I become indecisive.

EM

I'm currently doing a rotation in EM, which is one of my top contenders.Overall I have liked the rotation. Good variety, interesting cases. A lot of non-emergent stuff, and even some things that are more serious, get kind of routine after you do a few of them. I think it would be a nice fit for me based on the work alone.

The main thing I've been struggling with is the schedule. I'm a good bit older than most of my classmates. The whole day/night switching stuff is a bit of a grind. I can deal with it in the short-term. Not sure about doing it for30 years.

ANESTHESIOLOGY

Haven't done a full rotation yet. Doing it next block.
Did spend about 8 days with gas during my surgery rotation.

Like physio/pharm. Favorite subjects in the first 2 years.
Like the procedures. Like seeing immediate results from interventions duringthe cases.

Like EM, there is a big shiftwork component.

Not sure if Gas is better or worse in this regard.
Probably less "crazy hours", but a bunch more hours overall.
Less time to recover from off hour shifts. (I guess, job dependent).

Psych

Going into third year, this was probably my top choice.
Did some shadowing years 1/2, found it cool.
Liked learning about the psychopath in second year.

Got into my inpatient rotation and found I really didn't like the patients.
Dealing with an endless parade of schizophrenics just wore me down.
Even though they all had different stories, the treatment was basically the same. Pick an anti-psych med seemingly at random and hope for the best.

Keep them around for a week and then boot them out regardless of whether they got better or not.
This is a great exaggeration, but it seems like that was what was going on.

I did have a good time on the rotation, but that was mainly because I reallyliked all the people I worked with.
I did like working with the depression patients and some of the other stuff. But really wasn't too down with the inpatient environment.

Now you're probably saying, just cross this field off your list.
Which is what I pretty much did.

Thing is, I probably would see myself practicing outpatient psych where most of the patients would be depression, anxiety, that kind of stuff.
I think I would enjoy that, and probably be pretty damn good at treating those people.

Nice lifestyle after residency.

If I'm even thinking this now, I need to switch up my schedule and get in another rotation pronto. Can't pull the trigger on this one without another rotation.

Everything else

Surgery -never really considered it. Just not my thing

Medicine -liked the rotation. Don't want to do inpatient. couldn't see myself doing primary care. Don't want to spend forever in training doing a fellowship.

PM&R - didn't do a rotation yet. Like exercise, biomechanics, that kind of stuff. Nice lifestyle. Pretty regular hours after residency. Probably mainly thinking aboutit to get out of working nights in my career.

Bottom Line
I need to figure out how much I want/need to avoid the crazy hours that come with some of these fields. That's not the only thing, but it's a big part of my tihnking right now. I have no trouble working hard, but I just don't function all that well when my sleep patterns are constantly getting screwed.
Also, it's kind of a bummer having off when my spouse is working.

Fire away with any input.
Thanks.

While EM and anesthesia are mildly similar, they are nothing like psych. Is your main concern your schedule? I would just be careful that you don't pick a field based on perceived lifestyle, since you may end up being miserable, albeit for 40 hours a week. There are a lot of creative practice ideas out there in multiple fields that allow one to have a better schedule. Make sure you pick something that actually interests you, and you will still want to do 10, 20 and 30 years from now.

 

[PistolPete]

If I had to go with my gut based on the feel of your original post, OP, I would choose psych. If you really don't want shift work or late calls, then EM is probably out, and anesthesia is probably a little less likely. I guess it depends on what your priorities are.

EM, even as a partner at 40 years old, you will still have to work a decent amount of night shifts. If you can't imagine working at 3am when 40 years old, then EM is probably out.

Anesthesia probably has more controllable hours, but again due to the CRNA issue, you will still have to take 24 hr call once in a while and take on difficult cases. Whether or not you pursue this field depends on how much you love it.

Psych can have more controllable hours, but this field isn't for everyone, especially if you need to do procedures.

 

[MCAT guy]

ortho

 

[Tapepsi]

I completely hear you on the psychiatry thing. I was a psych major and while it has definitely helped me understand the mind and the mental development of children (I want to be a pediatrician or some specialty involving pediatrics), I know I do NOT want to be a psychiatrist. Listening to these horrible stories and dealing with these people who are so mentally distressed can definitely take a toll on you. I even shadowed a psychiatrist who told me that she regrets ever going into this field and that, if it weren't for her salary, she'd leave as soon as she could. But then again, there are psychiatrists who enjoy their work. It sounds to me though that, like me, you wouldn't enjoy it.

Good luck on making a decision.

 

[DrVanNostran]

I tend to talk to attending about 3 things:

1. Obviously the rotation I am on.
2. Sports
3. Picking a speciality

As for point number 3, more times than others, I hear them say after 20 years or so, this has sadly just become a job. Point being, what may make your pants wet now, may become just a dry paycheck later on. That kind of made me sway more in terms of lifestyle. I think I want to eventually be a 7-5ish kinda guy with call maybe once a week. For me, something outpatient will eventually give that.

 

[MossPoh]

I tend to talk to attending about 3 things:

1. Obviously the rotation I am on.
2. Sports
3. Picking a speciality

As for point number 3, more times than others, I hear them say after 20 years or so, this has sadly just become a job. Point being, what may make your pants wet now, may become just a dry paycheck later on. That kind of made me sway more in terms of lifestyle. I think I want to eventually be a 7-5ish kinda guy with call maybe once a week. For me, something outpatient will eventually give that.

That just depends on the doc. When they start cutting back hours it becomes a lot more fun again. I know my dad (who is now partially retired) hit a bit of a wall for a while but now I honestly can't see him NOT working a bit. Many people who consider something just a job get that way because they work so hard for so long they lose a little perspective. If you took a lot of those people away for a while then they'd be chomping at the bit to get back. Medicine is one of those fields that people seem to have a tough time full on retiring from and doing other things. Even if retired, they still seem to have a few medical type side projects going on.

 

[gman33]

So, I've been giving this a lot of thought.

The fields I see as the best fit are EM and Gas.
They both have an overnight component which I'm not too fond of.

I think I'm going to just suck it up and try to manage my sleep the best I can after residency. During residency pretty much every field is going to suck from an hours standpoint. I'm totally fine with that.

I already had a career that I couldn't stand. It had great hours.
I was miserable at work.
Can't go down that road again.

If I wasn't going to do one of this fields, I guess I'd be looking at some type of outpatient medicine gig. If I get sick of EM hours, I could probably find some type of urgent care gig. Probably take a pay cut, but that's not really a big deal to me.

Thanks for all the input.
Feel free to keep it coming.
I'll try to remember to post my final decision when I get there.

 

[DrVanNostran]

So, I've been giving this a lot of thought.

The fields I see as the best fit are EM and Gas.
They both have an overnight component which I'm not too fond of.

I think I'm going to just suck it up and try to manage my sleep the best I can after residency. During residency pretty much every field is going to suck from an hours standpoint. I'm totally fine with that.

I already had a career that I couldn't stand. It had great hours.
I was miserable at work.
Can't go down that road again.

If I wasn't going to do one of this fields, I guess I'd be looking at some type of outpatient medicine gig. If I get sick of EM hours, I could probably find some type of urgent care gig. Probably take a pay cut, but that's not really a big deal to me.

Thanks for all the input.
Feel free to keep it coming.
I'll try to remember to post my final decision when I get there.

This was one of my pros on my EM list. However, I am wondering how easy it would be to find an urgent care center in 10-20 years. My experience is only from my area, but they seem to pop up and disappear 5-7 years later.

 

[gman33]

This was one of my pros on my EM list. However, I am wondering how easy it would be to find an urgent care center in 10-20 years. My experience is only from my area, but they seem to pop up and disappear 5-7 years later.

Maybe not a stand alone center, but Fast Track or whatever they call minor care in the ED.

 

[gman33]

Finished my EM rotation. Really enjoyed the field.
Number of hours was pretty mild, but the switching around left me pretty tired. Days off were just times to sit around and rest. Not much motivation to really do anything.

Starting gas on Monday. I'll have to give it a good look.