Another help me choose a specialty thread

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The Brodie

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I’m an MS3 that needs to submit my 4th year schedule soon and I'm having trouble deciding which field I want to focus on. Step I 250+

So far I know I want a lot of patient interaction, to form relationships with patients/families, have colleagues I admire and get along with, and in an ideal world have a decent percent of my patients be motivated or at least not apathetic about taking care of themselves. I really enjoy diagnostic work-ups but that seems to apply to 90% of med students.

I like the hospital and clinic. I hate the OR.

I love the idea of primary care but worry that I’m not cut out for it. My classmates and family tell me I would be bored in a few years if I don’t subspecialize. I don’t care about income, though admittedly the lack of prestige in primary care could wear on me.

Personality wise I seemed to click with hematology-oncologists and neurologists this year. I’m more intense than most of the pediatricians I met (I can have fun but I'm just not as relaxed). Honestly, I seem most like classmates (intense, crazy self-expectations, etc) that are going into surgical fields but I don’t want to do anything procedural. Even though I am intense, I got great evals in Peds and was told I should go into by some of my attendings.

So I’m thinking Peds vs. Child neuro since I am soooo much happier when I’m working with kids and families. I know the bad outcomes can be tougher with kids, but I would still rather work with them than just adults. I did a rotation in Child neuro and loved the inpatient side- I woke up excited to get there and didn't want to leave at the end of the day. Yet, I felt pretty meh about the outpatient side of things. I'm not sure what it was about oupatient Child neuro that I didn't like (I was even working with the same team). I loved my outpatient and inpatient Peds experiences, but they didn't match up to how excited I was on inpatient Child neuro.

TDLR: Loooved inpatient child neuro, kind of disliked outpatient child neuro, really like gen peds in all settings.

I know I could do peds then subspecialize but I don’t want to apply to Peds if I couldn’t be happy without doing a fellowship.

Any advice on if I should hope that I could enjoy primary care or if I commit to Child neuro?

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Given your step score and assuming good LOR and clinical grades, you would probably be competitive at top peds programs, which takes some of the worry about not being able to subspecialize out - if you're coming from CHoP or University of Washington, you're probably going to be able to get into whatever subspecialty you want.

With that being said, have you consider peds onc or peds ICU? Oncology would have the workups you like, they often seem a little more cerebral, and you get those amazing outcomes (although also devastating ones).

Peds ICU would be all inpatient, very intense, super intellectually stimulating (at least that's how I felt about it).
 
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Intense type A that likes patients and didn't like surgery?

Sounds like Big 4 IM
 
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How about neonatology? Intense but friendly, meaningful work, overall pretty good outcomes for most, some heroic saves.
 
Because Big 4 IM is full of intense type A personalities, just like surgery, but not doing surgery
I met a type A in Family med the other day, Was completely confused by the intensity. Turned out it was a foreign medical grad that even did a surg prelim year before going into family.
 
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OP, Have you thought about Derm?
 
I've never considered given the amount of research I think you have to do to get into it.
ROAD are all waaaaay too chill for someone who describes themselves as a surgeon personality that dislikes the OR. Something like Big 4 IM into a very prestigious and lucrative fellowship (e.g. cardio --> EP) is what I'd peg you as
 
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Why not high tier IM into heme onc? With all the new targeted therapies I think it’s about to be the golden age of the heme onc doc
 
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ROAD are all waaaaay too chill for someone who describes themselves as a surgeon personality that dislikes the OR. Something like Big 4 IM into a very prestigious and lucrative fellowship (e.g. cardio --> EP) is what I'd peg you as

I'd have to say radiology isn't chill by any means. Less hours, but non-stop intensity on shift. That's part of why they've got great vacation packages.
 
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ICU is pretty intense (it’s in the name) can do it through neuro or IM or even peds but will make more $$$$ in the first 2. Have to do some procedures (lines, intubations) i imagine could outsource the lines but probably not intubations if you’re the only doc around
 
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I'd have to say radiology isn't chill by any means. Less hours, but non-stop intensity on shift. That's part of why they've got great vacation packages.
I mean the people/personalities. I dunno if you've done an elective in something like outpatient ophtho or derm, but there is also nothing chill about grinding through 40 patients per day
 
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I mean the people/personalities. I dunno if you've done an elective in something like outpatient ophtho or derm, but there is also nothing chill about grinding through 40 patients per day

Agreed.
 
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If you’re happier with kids, stick with a Peds specialty.

Despite the fact that there is a fellowship for Peds hospitalist, you can still be a hospitalist without the fellowship (just not as favored at an academic center). There’s also plenty of jobs for things like oncology hospitalist, urgent care, and mixed jobs where you manage an inpatient unit and still see patients in clinic. I think you could find a job in gen peds that works for you without a fellowship if you so choose. You can also still go into Neuro after a Peds residency, the process is just a little longer and slightly more complicated.
 
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Thanks everyone! I think I'm leaning towards Pediatrics and was just having a hard time admitting it to myself/everyone. I'll try to do some away rotations at more academically intense programs (I'm at a mid-tier school) and see if I feel like I fit in better.
 
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Thanks everyone! I think I'm leaning towards Pediatrics and was just having a hard time admitting it to myself/everyone. I'll try to do some away rotations at more academically intense programs (I'm at a mid-tier school) and see if I feel like I fit in better.
Based on classmates that are gunning for CHOP or Boston Children's, you'll fit right in
 
I'd have to say radiology isn't chill by any means. Less hours, but non-stop intensity on shift. That's part of why they've got great vacation packages.
It's mentally intense but does attract bright yet chill people.
Agreed, lol

Yeah, our radiology residents do "wellness walks" like 3x a day where they literally just go grab snacks and then walk around outside for a while. It's like recess lol. Very chill group of people.
 
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Yeah, our radiology residents do "wellness walks" like 3x a day where they literally just go grab snacks and then walk around outside for a while. It's like recess lol. Very chill group of people.

Yeah, one thing I find interesting about rads is that it's one of the few fields where the residency itself is relatively chill and then it's pedal to the metal as an attending.
 
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Yeah, our radiology residents do "wellness walks" like 3x a day where they literally just go grab snacks and then walk around outside for a while. It's like recess lol. Very chill group of people.

Even at my program, we take frequent breaks. We'll just grab a few residents, go down to the gift shop or food court or wherever several times a day.

It's even encouraged by many of our attendings. Eye strain and fatigue are very real, and taking frequent breaks keeps you fresh.
 
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Even at my program, we take frequent breaks. We'll just grab a few residents, go down to the gift shop or food court or wherever several times a day.

It's even encouraged by many of our attendings. Eye strain and fatigue are very real, and taking frequent breaks keeps you fresh.
I know this is a separate question but I will ask anyway.
What are some of the longest shifts that radiologists typically work?
Are there lulls in the reading room in terms of image ques? Like ebbs and flows of the ER.
I used to work for a small hospital and it wasnt unusual to see the radiologists taking a 45 minute lunch together.
 
I’m always going to plug my specialty but, honestly, a lot of what you said sounds like psych (relationships with patients, hospital/clinic based).

Approximately a quarter of the people in my program, myself included, either liked or even seriously considered surgery before deciding on psych, so even that is a lot more common than you might expect.
 
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I know this is a separate question but I will ask anyway.
What are some of the longest shifts that radiologists typically work?
Are there lulls in the reading room in terms of image ques? Like ebbs and flows of the ER.
I used to work for a small hospital and it wasnt unusual to see the radiologists taking a 45 minute lunch together.

The longest shifts are the 24 hour call by radiology residents. I don't know if that abomination still exists anymore, but it did when I was applying.

Otherwise, they're usually 8-10 hour shifts, up to 12-13 hours sometimes at my institution. But there's a lot of variation. For example, our overnight radiologists do 9 hour shifts for 1 week straight and then get 2 weeks off, a classic ratio for many places.

The biggests lulls are doing the day time when everyone else is at work. Once it's afternoon and everyone gets home from work, that's when things start to blow up. From my experience, things start to get busy around 4 PM here. Weekends can also be busy.

Volume is also a function of the catchment area. If you're in a densely populated area and you're the only hospital around for miles, the volumes will be high. If there are 3 hospitals within a couple of blocks from each other, the volume will be split.
 
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