Anyone choose their specialty based on the one they "hated the least"?

[Miss Walrus]

I’m curious if any of you chose the specialty you’re in based on it being the one you “hated the least”?

If so, what was the reason?

Did you not find anything you were passionate about after doing rotations or were you not competitive enough for your first choice?

Any regrets? Any positives?

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[BlondeDocteur]

It's an interesting question. (No, in my case). But in observing my classmates make their specialty choice I noticed that many people feel like if they "run the data" enough times, a perfect solution will emerge-- which is not true!

Every specialty has its downside. Part of choosing yours means that you acknowledge the downside exists and you're comfortable embracing it.

Here's how I think one should pick:

1) What am I intellectually attracted to? What sorts of problems within medicine do I find interesting?

2) Do I like higher acuity, lower acuity, or a mix of both? Do I have any preferred patient demographics (adults v kids v both; males/females/both)?

3) Can I put up with the bread & butter of this specialty? Can I find the nuances within the bread & butter interesting?

4) Can I make my peace with the downsides of this specialty (i.e. long hours, low pay, no patient contact, no respect from colleagues, only treat adults, whatever?)

5) Lastly, what are my associations with being a doctor? Is it just another job, now that the mystery has worn away, or do I think it's more like a calling/vocation?

 

[Miss Walrus]

I'm not sure if I ever believed a "perfect solution" would present itself. Rather, I imagined that deciding on what field to go into would involve choosing between a couple of fields you're really interested in vs. choosing between a couple of fields you're going to hate the least. I'm not sure how prevalent this outlook is, maybe it's just me.

I'm concerned about having regrets and with those I think you risk becoming bitter and treating it as a job rather than a calling (as you stated in #5) among other things.

This is probably just me having difficulty coming to terms with the whole process and honestly, if I was a more competitive applicant this process would be a lot easier.

Anyways, I appreciate your outlook/advice and thanks for your time!

 

[Shadowfeet23]

As an MS-IV who didn't discover my specialty choice until late in 3rd year, I agree completely with BlondeDocteur's observations. One aspect that I would like to highlight, however, is the importance of what patient population that you would like to work with the most and dealing with the negative aspects of the field.

For me, I found out about halfway through third year that I really wanted to work with those stricken with cancer. For personal reasons (family members afflicted with cancer) and the knowledge that many forms of cancer come through no fault of your own, I had the utmost sympathy for cancer patients. Not being the surgical type, it was down to MedOnc vs. RadOnc and I personally found RadOnc to be more intellectually stimulating and I feel incredibly blessed to be entering what I feel is the best field in medicine.

Conversely, I also had acquired somewhat of a disdain for the 320 lb McDonald's eating, no-exercising, smoking, alcohol drinking leach on our health care system. Call me a jerk (or jaded), but I didn't want to spend the rest of my life trying to help people that didn't really want to be helped.

Best of luck to the OP and all of you MS III's trying to choose a specialty.

 

[docB]

One of my lab partners in med school (in my med school you were assigned to groups of 4 and that was your group for the whole first 2 years so we all go to know each other pretty well) matched into EM because he "hated it the least." He's doing ok in it and this is 10 years out. We're all a litte burnt at this point. His issue is he probably shouldn't have gone into medicine. But once that die was cast EM was about the best specialty for him.

So it's a crappy way to choose no matter how you slice it but in his case it worked out ok.

 

[Law2Doc]

...
So it's a crappy way to choose no matter how you slice it ...

I think the above statement sums it up right. You aren't someone who doesn't have choices in life. so don't act like one. The dude who has to take the job stocking shelves at Walmart to feed his pregnant 15 year old wife has to take the job he can get that is the one he hates the least. Someone who gets into and through med school has lots of opportunities and choices in life and shouldn't be in this position. The rest of your life is a very long time. Don't treat it like a prison sentence. Take it from a career changer. Find what you enjoy, and do it. Don't waste your life on something you are merely tolerating.

 

[lowbudget]

I think the above statement sums it up right. You aren't someone who doesn't have choices in life. so don't act like one. The dude who has to take the job stocking shelves at Walmart to feed his pregnant 15 year old wife has to take the job he can get that is the one he hates the least. Someone who gets into and through med school has lots of opportunities and choices in life and shouldn't be in this position. The rest of your life is a very long time. Don't treat it like a prison sentence. Take it from a career changer. Find what you enjoy, and do it. Don't waste your life on something you are merely tolerating.

+1, actually +2.

If your mom and dad forced you into medicine, quit now. Sheesh.

 

[dragonfly99]

"quit now" may not be realistic advice for someone already 3+ years into med school and probably with big loans. Also, sometimes people (temporarily) get their hearts set on ubercompetitive fields like ortho, plastics, derm, etc. but then some figure out they have little or no chance to match into those. I think the OP's question is reasonable. He/she may find a field that's attractive in the next few months....3rd year is only 1/2 over or so...there's a lot of time left.

I would say consider some of the lesser known specialties. Some fields med students don't really rotate through...PM and R, nuclear medicine, pathology. I think sometimes people stumble into them at some point because they don't yet know what they want to do.

 

[docB]

"quit now" may not be realistic advice for someone already 3+ years into med school and probably with big loans.

That's why med schools never let anyone less than 2 years in near any clinical people. Once they see us they're at least $100K+ in debt and locked in.

 

[Miss Walrus]

I'm not exactly sure how my questions got interpreted as me being totally unappreciative of my situation. It's obvious that I'm fortunate to be where I am, but the reality is that choosing a career path isn't as "easy cheesy" as you make it sound; at least not for everyone.

Thanks to those who posted their experiences/thoughts without making bizarre assumptions.

 

[GuzzyRon]

Find what you enjoy, and do it. Don't waste your life on something you are merely tolerating.

👍 Word! 👍

 

[QofQuimica]

I'm not sure if I ever believed a "perfect solution" would present itself. Rather, I imagined that deciding on what field to go into would involve choosing between a couple of fields you're really interested in vs. choosing between a couple of fields you're going to hate the least. I'm not sure how prevalent this outlook is, maybe it's just me.

I'm concerned about having regrets and with those I think you risk becoming bitter and treating it as a job rather than a calling (as you stated in #5) among other things.

This is probably just me having difficulty coming to terms with the whole process and honestly, if I was a more competitive applicant this process would be a lot easier.

Anyways, I appreciate your outlook/advice and thanks for your time!

Are you a third year? If so, I think it's too soon for you to give up all hope of finding a specialty you enjoy. Like dragonfly said, there are so many specialties that most third years get zero exposure to, such as preventive medicine, PM&R, path, surgical subspecialties, medicine subspecialties, critical care, and more. My suggestion is that you go through your school's elective catalog and pick out a few that you think sound interesting. If your third year ends in May or June, you will have a few months of elective time that you can use to check out some of these alternative specialties before it's time to apply for residency.

Again, don't give up all hope before you research more options. I was on the late side figuring out what I wanted to do, but I did find a subspecialty that I am really excited about. One of my friends who spent all of third year feeling frustrated about not liking anything very much ended up deciding on preventive med, and it's seriously the perfect fit. It wasn't even my epiphany, but I was excited about it too because it was such an obvious right choice once we started talking about it.

 

[Miss Walrus]

Are you a third year? If so, I think it's too soon for you to give up all hope of finding a specialty you enjoy. Like dragonfly said, there are so many specialties that most third years get zero exposure to, such as preventive medicine, PM&R, path, surgical subspecialties, medicine subspecialties, critical care, and more. My suggestion is that you go through your school's elective catalog and pick out a few that you think sound interesting. If your third year ends in May or June, you will have a few months of elective time that you can use to check out some of these alternative specialties before it's time to apply for residency.

Yes, I'm a third year. I think your approach is solid, but I'm just not competitive enough (board score wise) for a lot of specialties.

I think what I'm trying to do now is gather up a final assessment/personal inventory (like suggested earlier) and try and match it to specialty descriptions provided by sites like AAMC CIM. I've already done some of the assessments (ie Pathway Evaluation Program) and it's been a good start, but I'm not sure how accurate these programs are in evaluating your interests.

 

[QofQuimica]

Yes, I'm a third year. I think your approach is solid, but I'm just not competitive enough (board score wise) for a lot of specialties.

I think what I'm trying to do now is gather up a final assessment/personal inventory (like suggested earlier) and try and match it to specialty descriptions provided by sites like AAMC CIM. I've already done some of the assessments (ie Pathway Evaluation Program) and it's been a good start, but I'm not sure how accurate these programs are in evaluating your interests.

I don't think those programs are as good as actually doing a rotation for a month in that specialty, and even doing a month-long rotation only gives you a taste of what the specialty is like.

Not knowing exactly what you define as "not competitive enough," I still think you have a lot more options that you may not have considered and that don't require sky-high board scores. Also, if you're still a third year, you haven't finished all of your required rotations yet either, so there still could be something you like. Maybe surgery subspecialties could be a stretch, but all of the other things people listed are possibilities.

Does your school not offer career counseling to the students? They may have some suggestions. Also, if you go to the ACGME website, you will see their list of recognized specialties and subspecialties. Again, there are a lot of possibilities out there that you don't get exposure to as a third year in most cases.

 

[greenbean]

Yes, I'm a third year. I think your approach is solid, but I'm just not competitive enough (board score wise) for a lot of specialties.

aside from the great advice the others are giving you, i wanted to give you my perspective

it is critical to ASSESS YOURSELF, not just what you like or not, not just the pts you like or not, not just the diseases you find interesting or not. But YOU as an object , in the eyes of a program director(IE your future boss)

your step one is the incredibly important, probably the most impt;it will help say whether you are 'competitive' enough for specialty x or not; for instance if you have a score of 220(average score) and you want something like derm/radonc/plastics, forget it, but if you want neurology, very easy; if you want IM, very easy

why am i telling you all this ? well, like you, i had no clue what i wanted to do, my boards were average, i passed everything, got honors here and there; i ended applying to ophtho b'c i 'loved' the work, pts, diseases, residents i worked with, the research i did; i was told by my dean that i should be able to match..but i didnt and it was devastating, not just psychologically but also scary b'c i had NO back up plan, so i ended up scrambling into another field. and scrambling was a horrible experience, believe me you dont want that

in hindsight, it would have been been to choose a field that i liked and could DEFINITELY match it; and not gamble as i did or apply to 2 specialties

peace and gl,
green

 

[bullpup777]

My medical school was probably not a good choice for me. I really didn't like anything an awful lot, except my Sub I at the VA, but I did that after having already chosen a specialty. My medical school uses all private, high profile hospitals for rotations, and it never occurred to me that this patient population might be my problem.

When I went to do my med prelim year at a big city charity hospital, it was a whole new world. By the time I got over being absolutely terrified, i realized I was blissfully happy and having the time of my life. I think that it is hard to know what you really love based on a year and a half of medical school clerkships.

Eventually you should find what you love as you blunder about the world of medicine.

 

[medsRus]

My medical school was probably not a good choice for me. I really didn't like anything an awful lot, except my Sub I at the VA, but I did that after having already chosen a specialty. My medical school uses all private, high profile hospitals for rotations, and it never occurred to me that this patient population might be my problem.

When I went to do my med prelim year at a big city charity hospital, it was a whole new world. By the time I got over being absolutely terrified, i realized I was blissfully happy and having the time of my life. I think that it is hard to know what you really love based on a year and a half of medical school clerkships.

Eventually you should find what you love as you blunder about the world of medicine.

I love this self-analysis.

 

[vhawk]

My medical school was probably not a good choice for me. I really didn't like anything an awful lot, except my Sub I at the VA, but I did that after having already chosen a specialty. My medical school uses all private, high profile hospitals for rotations, and it never occurred to me that this patient population might be my problem.

When I went to do my med prelim year at a big city charity hospital, it was a whole new world. By the time I got over being absolutely terrified, i realized I was blissfully happy and having the time of my life. I think that it is hard to know what you really love based on a year and a half of medical school clerkships.

Eventually you should find what you love as you blunder about the world of medicine.

I think this is a really good post and I really like your honesty. But what if your last sentence isnt true? I basically feel the same as you, I probably chose the wrong med school for a variety of reasons, and probably should never have gone to med school in the first place. However, I was lucky enough to stumble into a field that I really enjoy, which was nice considering I absolutely HATED basically every single other rotation the entire year.

But what if you and me are just lucky? What if you DONT just find what you love as you blunder around? I have a ton of sympathy for those classmates of mine who, as the Match Day clock ticks down to zero, either ranked multiple specialties (!) or withdrew from the Match entirely because they didnt know what they wanted, and are taking a year off for research/soul-searching.

I cant really share the same enthusiasm that posters above have that we are all bright and have the world open to us. Yes, that was true....4 years ago. Its not true now. Obv having a MD gives one more choices than having a pregnant 15 year old girlfriend (especially for me!) but our Wal Mart clerk also isnt saddled with a quarter million dollars in debt. The "flee to California and start a rock band/be a bartender" route is still available to him. Dont get me wrong, I wouldnt trade spots with him, but I dont think its all that helpful to say "ZOMG someone has it worse than you stop whining!"

I feel incredibly lucky that I was able to blunder into something I liked, and I hold no illusions that it was fated or would have happened eventually. I also might be wrong...maybe my one-off experience with a small handful of attendings in 2 or 3 hospitals really isnt indicative of what my field will really be like, and I'm just putting off my desperation for 5 years. I'd love to buy a beer for all those who are going through it right now.

 

[dragonfly99]

I think the masses are being a little harsh on our little Walrus. She's just a little dysthymic as reality sets in...the reality is that most med students are gunners, and smart, and only 1/2 can be on the right half of the bell curve on any given exam, or clerkship. Some people are just really bright and skilled, and some are just good at playing those games that need to be played on clinical clerkships. It's a little hard to take when someone starts force-feeding you lemons when you used to be getting lemonade served to you by a butler on a silver tray (high school) ...or at least you had some serviceable Kool Aid lemonade stocked in the cabinet that you could mix up (college) or at least a drink of water (1st/2nd year med school).

MissWalrus,
I would also add that you might be more competitive than you think for some specialties. If you are only a 3rd year, then all you have is 1/2 of 3rd year and your Step 1 scores and whatever grades you made in 1st/2nd year. You can still push like heck to do as well as you can for the rest of 3rd year and beginning of 4th year. I agree that you aren't competitive for the plastics/derm/ortho maybe radiology, opthalmology type stuff, but I think as a student I had this perception that even anesthesia and ER were only open to people with really high scores and lots of Honors in 3rd year. I don't really think that is true. Some of it depends on whether you are MD or DO, whether your school is well known, and where you are willing to go. Have to take inventory - are you gunning for something like ER or anesthesia, and willing to go out in the middle of nowhere in the cold Midwest or some inner city hospital where you'll get worked to death, or would rather do IM at a more cushy spot or a more popular city?

Sometimes IM is used as the default choice for people who don't know what they want to do. I think that is OK, but you have to like adult patients and you have to have a toleration level for hands-on clinical medicine and to tolerate some social work issues.

Sometimes if you are not super competitive for a particular field, a year of research after 4th year, or extending med school another year w/research blocks but getting your school to not graduate you until the following year, could make you more competitive. It's not going to get you into derm with a 200 Step 1 score, but it might help you squeeze into a field like ER, gas, or even something like radiology, depending on your overall application (not just Step 1 and 3rd year clerkships alone).

 

[Miss Walrus]

Thanks for all of the responses, but to address just a few...

Does your school not offer career counseling to the students?

Not really. The department essentially looks at your board scores and compares you to students who have previously matched from your school in whatever specialty you're inquiring about. Outside of that, they have some e-mail addresses of Docs who are supposed to help students with questions about their respective field, but they rarely respond to student inquiries.

Sometimes if you are not super competitive for a particular field, a year of research after 4th year, or extending med school another year w/research blocks but getting your school to not graduate you until the following year, could make you more competitive.

How common is this and is it looked down upon?

 

[Cirrus83]

Burnout is unsurprisingly pretty common 3rd year so I think one problem is that you might start viewing everything through dark grey tinted lenses if you will. Everything is dark and dreary, and you're exhausted and trying to study after quite a few hours of work. And it's understandable why you might start to feel like you hate everything.
I suspect though that there's at least one specialty that you'd at least find somewhat enjoyable assuming you weren't insanely sleep deprived while doing it, and had just had a great weekend with your friends and family.
Hang in there, it's almost over anyways 😉