Another pick a specialty thread

[goremachine]

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Alright, here's another thread to help out anyone who feels lost and is having trouble figuring out what they want to do.

The problem as I see it, is simply not having enough elective time before we're forced to decide on a specialty. I've already used up all of my elective time for this year, and I won't be able to do another elective until July. And applications are due in September. So, it's tough.

So here are my thoughts on a few fields I'm considering, and my very biased, narrow perceptions of them.

Hopefully other MS3s who are having trouble deciding on a specialty can post their own thoughts in this thread and get something out of it.

What I like/am good at: 3D visuospatial thinking, puzzle solving (I liked organic chemistry), anatomy, variety, being in the OR, quick interventions, talking to smart, involved in their own care patients.
What I dislike/am not good at: rounding, chasing numbers, gomers, writing notes, waking up early.
What I would eventually want in a career: lots of variety in practice, and living/working in a large metro area, which are sadly not often compatible.

Where I'll be standing at the beginning of 4th year: 260+ Step I, mix of Honors and High Pass in rotations, most likely not AOA, no research whatsoever (I did a little bit in college -- I REALLY hate research, but have pretty much resigned myself to the fact that I'll have to do some in residency to get a fellowship), hopefully fairly decent letters of recommendation.

So far, I liked my neuro rotation, hated medicine, hated psych, liked ophtho, liked ENT, liked radiology.

Here's what I'm considering:
Ortho -> Ortho Trauma, Spine, or Hand

Along with plastics, one of the 'operate all over the body' specialties. I think plastics would also be really cool, but am not willing to put in the research and asskissing time required to match in it.

positives: trauma can be fun, variety of procedures, generally healthy patients, variety of fellowships are open after residency
negatives: surgical lifestyle, ortho trauma isn't really life-or-death and mostly just tedious call, if you want to make it in a big metro area, you have to sub-sub-specialize, and be the guy who only does right ACLs, most ortho residents aren't that interesting, although I'm sure that depends a lot on the program

ENT

positives: interesting anatomy, all of the ENT residents in the rotation I did were pretty chill, overall less malignant than nsrg and probably ortho
negatives: very competitive, still a surgical residency, private practice ENT in a big city is mostly tubes and T&A

Rads -> Interventional or Neurorads

positives: relatively easy to match into a good program (although interventional fellowships are tough to get), a lot of visuospatial thinking, get to learn anatomy really well, good variety of studies (at least in residency), rads lifestyle, residents tend to be pretty cool
negatives: might get really boring really soon, no patient interaction is nice at first but might lead to a feeling of not being a 'real doctor'

Rad Onc
I don't know much about this field, I'd like to do an elective, however, I don't think that 2 months at the beginning of 4th year would give me time to put together a compelling application.
positives: a lot of visuospatial thinking and 3D planning, Gamma Knife surgery is cool, awesome technology in general
negatives: virtually impossible to match without research and AOA.

Ophtho -> Retina
positives: retina surgery is pretty much some of the coolest stuff I've ever seen, overall cool but a little boring residents, good lifestyle, diagnosis is made via physical exam on pathology you can actually see, all the cases are done sitting down
negatives: very competitive (retina even more so), ton of clinic and benign exams, market is completely saturated in big cities

So that's about how I see things at this point. Hopefully by the end of third year I'll feel like I have some more direction, but I doubt it, since I'm pretty sure I won't be going into general surgery, ob/gyn, or pediatrics. Any other specialties I should be considering? Anyone else was in a similar position 3rd year? What did you end up deciding?

 

[dragonfly99]

First of all, congrats on your great step 1 score, and on thinking ahead.
I am far from an authority on surgical specialties, or on radiology, so take all this with a grain of salt.

It sounds like you might do well in many of these areas.

Be aware that any kind of trauma surg (ortho trauma, general surg trauma, etc.) you'll have > normal gomer-type patients (b/c these types get themselves injured more often) and you'll have a crappy lifestyle and be getting up very early. Ortho spine...more planned schedule but my impression was lots of kissing ass to get a good spine fellowship and also it looks like it would get very tedious/repetitive after a while. You had better make sure you like being in the OR long hours doing laminectomies or fusions, etc. I don't see that there is much variety there. The ortho and plastics hand people seemed pretty chill when I was around them...lifestyle seems pretty good except if you are an academic ortho you may have to share ortho trauma call (even if you are a hand doc, etc.). ENT the residents and attendings @my med school were very chill and smart...it seems like a pretty cool specialty and a little easier to match than ortho or plastic surg...seems like there is some variety too. Be aware that you'll have lots of cig smokers and heavy drinkers among the adult ENT surg population b/c that is who gets head and neck CA...some are nice but a good deal of personality disorders, etc. as well (alcoholics, etc.).

Radiology is a good choice if you like people who are chill and don't like getting up early...any surgical residency you are going to get reamed the first few years and be getting up **** early in the morning. Depending on the surgical subspecialty, this may continue forever vs. not (i.e. not necessarily great hours as an attending either). The drawback of radiology is little patient contact...but that can also be a plus...some patients you don't want contact with them, LOL! Also you have to be able to sit in a dark room all day. If you are good at physics and math, and are detail oriented, you might go for radiology. They make great money and they work nice hours.

Ophtho...pretty chill residents and attendings, and very smart. Have to worry about developing a niche, probably do fellowship unless you want to get aced out in the job market. Also have to worry about optometrists trying to take your job, unless you have a surgical niche (IMHO). Not many emergencies/middle of the night calls, though it does happen for detached retinas and eye trauma/injuries.

I think you are correct about the difficulty of matching in rad onc. I would think you'd have a chance with your 260, provided you are in the top 1/3 of your class (not necessarily AOA even) but I really don't know. I would think that having done a rotation, and getting a LOR from a rad onc person who is well known would be as important as being AOA. Rad onc makes a ton of money and apparently has great hours, but I really don't know exactly what they do all day to be honest. They don't round, I can tell you that!

I don't think you should do neuro if you hate rounding and hated your medicine rotation...you'd just want to shoot yourself before you ever got to your "interventional neurology" fellowship, and you could just go that route by doing interventional radiology anyhow...

I think you are correct in thinking that is you want to be in a large metro area most of the surgeons are more subspecialized, but you can do this...you are going to match well and if you plan ahead you can sub-subspecialize if you need to.

You really sound like a surgical person, except that you don't like to get up early. I would suggest a surgical subspecialty that lends itself to a fairly chill lifestyle in actual practice...plastics or ortho hand, probably ENT, optho, if not one of these then interventional rads come to mind. You have to take an honest look at yourself and the lifestyle you are willing to tolerate during residency as well as the rest of your life. If you truly want a chill lifestyle and not to get up early, then I think radiology and ophtho match that best. I really think you need to do a surgical subI next summer...preferably two of them...to be able to reasonably evaluate things. It will be interesting to see what the surgeons say.

 

[dragonfly99]

Oh you (and I) forgot to mention urology. It is definitely hard to match into that...or it was last I looked. However, they are chill, have a generally very good lifestyle out in practice, and it's less brutal than most other surgical residencies.

 

[bluealiendoctor]

Are transitional years generally easy for those going into ENT? I only say that because I know a DO who is doing a transitional year and it is the easiest schedule I've ever heard of. This person has never worked over 50hrs/week, was Q7 during medicine and Q7 during surgery. While doing peds...averaged 30hrs/week.....and has worked only 3 weekends since July 1st. Is this normal? I'm just a little irritated because he/she keeps complaining of how tired they are after a day of 8am-4pm....which is a long day.

 

[goremachine]

Transitional years depend on where you go, they can be benign or they can be malignant. Also, it depends on the ENT program that you're doing. Here, ENT is a fully integrated residency, the interns do 2 months of ent, 2 months of neurosurg, a bunch of other stuff. I would imagine that most ENT programs require a surgical internship, but some might let you do a transitional year as well.

 

[BlondeDocteur]

I find it interesting that you hated medicine but are strongly considering ENT, ophtho and urology. They're each fascinating fields but all three have a signficant amount of clinic time, since there is no "medical" counterpart to their "surgical discipline" (versus, say, neuro for neurosurg, PM&R for ortho, etc).

If you enjoy puzzle solving, spatial analysis, motivated patients, variety and OR time, to be frank you sound like an excellent candidate for plastics. However, if plastics is out for you, then it's out.

Ortho for the most part becomes very repetitive, as [my perceived] goal of the specialty is to learn to do a specific procedure in an entirely reproducible way. Ortho is in fact the only surgical subspecialty I didn't enjoy, for precisely that reason.

Of all your options, I actually think urology might be the best fit. It has a gentler surgical subpsecialty lifestyle, fascinating operations (by far the best procedure I've scrubbed into yet was a cloacal repair on an ex-conjoined twin), an absolute area of expertise, and minimal note-writing. You can do everything from surgical oncology (treat GU tract cancer) to infertility/reproductive endocrinology to congenital anomalies. They have wicked cool technology too (they make the most use of the Da Vinci robot; when they laser down a prostate for a TURP it looks like a radioactive video game).

I agree that radiology/interventional radiology/interventional neurology triad is probably not what you're looking for. I too, despite working at Memorial Sloan-Kettering, have no idea what radiation oncologists actually do, so I have no advice there.

The best thing? Browse through the journals in these fields, and see which one(s) you're intellectually attracted to. Shadow during your lighter rotations. And if you choose a field that requires a bit of research, you can attach yourself to a few projects this spring and get a couple of abstracts/chart reviews published.

 

[goremachine]

Lots of good points here. I definitely think you're right in regards to the ortho aspect -- while there's a lot of variety in terms of what you can do in residency, in practice, you have to pick something and do those over and over to become truly proficient at it.

I hated medicine, but it was more the inpatient day-in day-out aspect of patient care that drove me crazy. Also all of the outside work we had to do for the rotation was miserable. I actually enjoy clinic sometimes -- it really comes down to the patient population. Ophtho is a bit too much clinic, too little OR time for me. ENT seemed like a nice balance though.

I haven't seen any of urology or plastics yet, so I can't really comment on those. In theory, I do like the fields though.

I agree with you that plastics would probably be a good fit. I plan on doing an elective in it on my surgery rotation next semester, I'll see how that goes. I would definitely have to make my application a lot more competitive though, besides my Step I, I don't have much going for me. I would strongly prefer to stay in NYC for residency, but I suppose beggars can't be choosers. Especially not in matching for plastics.

 

[Pir8DeacDoc]

Just to echo some of the points made above.

- Gomers are everywhere in medicine. You might as well get used to it or go into a field without patient contact like pathology or radiology

-I agree with the points about urology and ENT. While ENT is a surgical subspeciality we deal with a lot of non-surgical stuff. I think the last someone mentioned to me was 1/7 patients you see in clinic is an OR patient. Maybe more or less depending on what area of ENT you go in to. Plus, if you don't like early morning it's hard to think that surgery is your thing. We don't get in super early but certainly we are in by 6 or 6:15 at the latest.

Good luck, it's super tough to figure out all this stuff on such limited information. It took me awhile to get things worked out for myself and I can appreciate your predicament.