Best residencies for nontradiational students

[newtoPA]

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Any recommendations? I am looking into internal medicine, family practice, dermatology, or allergy immunology.

 

[Dral]

Whatever you want. Some people say to stay away from surgery due to the grueling hours, but that's personal choice.

I started med school at 33 and am finishing up Derm residency now...off to dermpath fellowship next.

 

[SLC]

Allergy and immunology seems like it would take longer than I'm willing to take at this point. Isn't it a fellowship after IM?

But what the poster above me said, anything really...

I think non-trade have a lot to bring to primary care. They are eminently relatable and have real world experience that patients appreciate. It's not glamorous, and non-reads are certainly not restricted to primary care, but I think they tend to do particularly well.

 

[newtoPA]

I may try to shadow doctors in these settings. I may also consider emergency.

 

[doc05]

how nontrad? how old are you? past a certain age, the long hours of certain residencies (everything in surgery, many IM programs) will be a poor choice.

derm, path, pm&r are good choices if you're older.

 

[newtoPA]

I'm reaching my early 30s.

 

[koikisi]

Agree with others. How about Psychiatry? I am also a fairly non-trad, was going to do Family Practice, but decided Psychiatry at the last minute when applying. Even EM has quite a few nontrads in my experience.

 

[doc05]

have you started med school yet? age at graduation? I don't mean to be nosy, but this will make a difference.

once you're out in practice, it doesn't really make a difference.

but, past a certain age, you're not going to want to deal with the long hours, many years in training, overnight calls, and hierarchical b.s. of certain specialties.

 

[koikisi]

have you started med school yet? age at graduation? I don't mean to be nosy, but this will make a difference.

once you're out in practice, it doesn't really make a difference.

but, past a certain age, you're not going to want to deal with the long hours, many years in training, overnight calls, and hierarchical b.s. of certain specialties.

Every specialty has hierarchical BS. Not necessarily every program, but you can find them if you look hard enough.

 

[newtoPA]

@doc05 which one usually has overnights? From what I understand, EM could have overnights.

 

[bashwell]

Any recommendations? I am looking into internal medicine, family practice, dermatology, or allergy immunology.

Dermatology is very competitive to get into. It can have a great lifestyle. But you'd better be at the top of your game once you start med school (e.g. high Step 1 scores, maybe even take Step 2 and smash it, research in derm always helps such as posters or presentations and of course published papers, honor all or most of your 3rd year rotations, AOA, etc.).

Allergy/immuno has a great lifestyle too, but you have to go through IM first. Right now there are few jobs in A/I or so I've heard. It's moderately competitive to get into A/I from IM too.

IM residency can be as hard as surgery, depending on the program. Life as a hospitalist can be hard too. But IM has the most options and you can do all sorts of things coming out of IM so it can still be a good choice, like if you want to subspecialize.

FM is very flexible. It's in huge demand right now. You can be work in the city, rural, work in rural EDs, etc. It can have a decent lifestyle.

Of course, all of these involve clinics (even ED I think of as a big clinic seeing multiple patients simultaneously interspersed with emergent situations). But if you go to med school and find you hate clinics, then these might be out! It's good to have an idea of various specialties now, but best not to worry too much like which one to do for now.

For shadowing just pick whatever sounds interesting to you. No one will expect you to know anything. If I were you I'd pick FM to shadow because they tend to be very nice in my experience and you can see a broad range of pathologies. Or ED is cool too if you go during the week so it's not as busy and EPs will have more time for you.

I'm reaching my early 30s.

You can still do anything if you are starting residency in your early to mid 30s. But I've heard once you reach 40-ish, then things start getting a bit more tough on your body.

At the same time it's hard to say definitively because everyone is different. If you're a fit and healthy 40 yr old who runs marathons or triathlons or otherwise is active and has a good healthy diet and so on, then I imagine you'll likely be ok even in physically grueling specialties like surgical specialties. But if you're an unfit or obese 30 yr old, then it could be more difficult.

@doc05 which one usually has overnights? From what I understand, EM could have overnights.

Yes most EPs do work nights, weekends, and holidays for most of their careers.

My opinion: I'd say EM is hard for all ages because of its shiftwork. One week you could be working regular shifts, then the next week night shifts, etc. It keeps changing from week to week. So it messes with your circadian rhythm. EM is currently very popular in the US, but in other nations EM is considered one of the least desirable specialties, and a lot of it is because of these rotating shifts. On paper, it may sound really good to only work 8-12 hrs x 4-5 days per week and have no call, etc., but these can be very physically hard shifts if the shifts are like shifts in residency, you could be working when friends and family are at home, although sometimes you could be totally free one morning and afternoon and do whatever like go shopping when no one else is around which is nice - but it's also not nice since most of your friends or family will probably be working and so you may have to go alone. There are some nice setups like if you work for a FSED in TX, but that's not the case for most EPs. Anyway at least in my experience, EM can be a recipe for burnout, and I say this as a total night owl who thought I wouldn't mind. But some people can do it and do it well. I know EPs have various ways to ameliorate burnout. But again I find it's still hard, though I respect EPs for doing it.

Check out posts by people like @Birdstrike if you're interested in EM.

All this said, I take it you're not in med school since you say "EM could have overnights," as if there were any doubt, but this would be known and obvious if you're in med school. So if I were you I wouldn't worry about which residency is good for non-trads right now. I'd just focus on getting into med school if that's what you really want. It's not too late: If you're early 30s now, then (assuming you've already done all your pre-reqs and MCAT etc. and start right away) you would be starting med school also in your early 30s (e.g. 33). You'd be done with med school after 4 years, so say by your mid-to-late 30s (e.g. 37). You'd be starting residency in your mid-to-late 30s (e.g. 37-38). That's not too bad. If you haven't done all your pre-reqs then just add another 2-3 yrs to your age. Finishing by 40 ish still isn't too bad. You'd still have a good 20-25+ yr career ahead of you.

Good luck.

 

[Ismet]

Moving to non-trad forum

 

[doc05]

@doc05 which one usually has overnights? From what I understand, EM could have overnights.

yes EM does. IM, surgery have overnight calls throughout residency. the best fields to avoid this...

path
derm
ophtho
pm&r
psych

 

[DrMidlife]

"Overnights" happen throughout the 3rd and 4th years of med school and intern year. You've got to get through 5 years of training, not on your terms, to get to where your less strenuous specialty choice is any less strenuous.

Nobody is particularly fond of the hours, whether you're 21 or 51. It's just part of the game. The 21 year olds are just as wrecked post-call as I am at 49. Work ethic matters a lot more than age.

Trying to pick a low impact specialty as a premed because you're worried about being older makes less sense than considering whether medicine is really the best choice vs. other career choices. Dentists, PTs, etc have as much autonomy and income as MD or DO, with far shorter training and far fewer lost income years. Take a look at ramusa.org and see if you still think being a physician is the most helpful and impactful health care career.

Basically if you're worried now about having enough energy to keep up with the kiddoes, that's a bad sign. The endlessness of med school and residency, the loss of other opportunities, the loss of the highest yield investment years of your life, the strain on relationships, the debt - these issues are what you really ought to worry about. Low energy or feeling your age will just make it more likely that you don't make it through pre-clinical years, much less the call schedule of 3rd year.

Best of luck to you.

 

[newtoPA]

@bashwell, @doc05 and @DrMidlife These are very good responses. I am going to keep this in mind. I'm not worried about keeping up with people, but I am considering the realities of committing to something before doing it.

Independently managing finances to complete the program, and get the license.

I am also thinking about what the schedule would look like in relation to my own life now. This includes overnights for some specialties. Managing time to treat the patients with autonomy and delegation.

I am considering EM, IM, FMP because most medical training seems to be more focused on these specialties. That is why I am considering those fields. In my personal life I had good doctors who treated me in allergies and dermatology. That is also why I considered these two specialties.

I plan to shadow doctors soon.

 

[bashwell]

@bashwell, @doc05 and @DrMidlife These are very good responses. I am going to keep this in mind. I'm not worried about keeping up with people, but I am considering the realities of committing to something before doing it.

No worries, glad to help! 🙂

It's hard to know what med school and residency are like prior to doing them. It's not just the financial costs and many years it takes to become a doctor, nor the working nights, weekends, holidays, etc., but also the emotional and psychological strains, the hierarchical nature of much of medicine, the loss of autonomy to always be able to do what you want when you want, the pimping, the scut work, the daily/weekly/monthly/yearly grind, etc. These can take their toll on a person. They can be hard on your family too if you have a family or plan to have one. Make sure they're on board too because it's very helpful if not essential to have their support over the years. As you're doing, just keep trying to get as clear a picture of what you're jumping into before you dive in, as much as possible (though I realize it's not totally possible, but again just as much as you can). There are moments of joy too (e.g. your first diagnosis). But plenty of sacrifices to make as well.

I am considering EM, IM, FMP because most medical training seems to be more focused on these specialties. That is why I am considering those fields.

I'm not quite sure what you mean by "most medical training seems to be more focused on these specialties."

FM and EM do see "everything" in the sense that they can see undifferentiated patients (especially EM) with all manner of pathologies, and they can see everyone from pregnant women to kids to adults and geriatric patients. They can see it "all." But EM also needs to know how to handle emergent cases, while FM has to be able to manage chronic disease well. In this respect it's true they cover a wide breadth of medicine.

IM deals primarily with adult medicine and in residency it'll be mostly in the hospital setting. It's also attractive because you can subspecialize in a plethora of subspecialties (e.g. cardiology, gastroenterology, pulm/critical care, hematology/oncology, infectious disease, etc.). So IM covers a lot of ground too.

However, a lot of "medical training" is also focused on surgery, for example, which EM, IM, and FM don't do, yet surgery is obviously integral to modern medicine.

You'll have core rotations in specialties like IM, surgery, psychiatry, family medicine, pediatrics, OB/GYN, etc. So just make sure to keep an open mind.

Also there's a lot of specialties which aren't core specialties but which may be very desirable depending on what you like, etc. (e.g. radiology, pathology, anesthesiology, urology, orthopedic surgery).

In my personal life I had good doctors who treated me in allergies and dermatology. That is also why I considered these two specialties.

I presume they're telling you these are good fields mainly because of lifestyle. But one problem is you have to at least like these fields enough to enjoy doing them as a career.

Speaking for myself, I did a rotation in derm and actually found I didn't like it, despite seeing interesting patients and cool cases (e.g. eczema, psoriasis, BCCs, SCCs, melanomas), and helping out on things like Mohs surgeries, light therapy, etc.

Another consideration is what the job market is like. I have a friend who is in allergy/immunology. He does well, but apparently it's tough for newly minted allergists/immunologists to get jobs right now. Maybe things will improve by the time you are deciding. But I enjoyed allergy/immunology more than derm, personally, although more immunology than allergy even though allergy is probably more the focus in PP. The pay is a lot better in derm even if the lifestyles are similar.

 

[newtoPA]

@bashwell Awesome post.

 

[jl lin]

"Overnights" happen throughout the 3rd and 4th years of med school and intern year. You've got to get through 5 years of training, not on your terms, to get to where your less strenuous specialty choice is any less strenuous.

Nobody is particularly fond of the hours, whether you're 21 or 51. It's just part of the game. The 21 year olds are just as wrecked post-call as I am at 49. Work ethic matters a lot more than age.

Trying to pick a low impact specialty as a premed because you're worried about being older makes less sense than considering whether medicine is really the best choice vs. other career choices. Dentists, PTs, etc have as much autonomy and income as MD or DO, with far shorter training and far fewer lost income years. Take a look at ramusa.org and see if you still think being a physician is the most helpful and impactful health care career.

Basically if you're worried now about having enough energy to keep up with the kiddoes, that's a bad sign. The endlessness of med school and residency, the loss of other opportunities, the loss of the highest yield investment years of your life, the strain on relationships, the debt - these issues are what you really ought to worry about. Low energy or feeling your age will just make it more likely that you don't make it through pre-clinical years, much less the call schedule of 3rd year.

Best of luck to you.

Agree, but after 40, for most people doing surgery seems to be pushing it. It will depend by the individual. Regardless of age, I've like working as a RN with surgeons, but no. Can't say it would be my top choice at this point in my life--but neither would OBGYN. As far as ED, I find it to be a great specialty, but I have worked enough off-shift. Granted, got to get through the training and the hours it entails. After that, I don't want to be doing the craziness of off-shift on a regular basis anymore. Primary care seems most reasonable for someone like me. I mean, I do have to be realistic. I am going for something that I can work in past typical retirement ages; especially since I see a lot of people get depressed and go downhill after retirement. I'm certain this isn't everyone; but I want to keep busy as long as I am able. A nice % of the primary care physicians I know are working into and beyond 70. As long as you are healthy and in good shape, why the hell not?

 

[bashwell]

Agree, but after 40, for most people doing surgery seems to be pushing it. It will depend by the individual. Regardless of age, I've like working as a RN with surgeons, but no. Can't say it would be my top choice at this point in my life--but neither would OBGYN. As far as ED, I find it to be a great specialty, but I have worked enough off-shift. Granted, got to get through the training and the hours it entails. After that, I don't want to be doing the craziness of off-shift on a regular basis anymore. Primary care seems most reasonable for someone like me. I mean, I do have to be realistic. I am going for something that I can work in past typical retirement ages; especially since I see a lot of people get depressed and go downhill after retirement. I'm certain this isn't everyone; but I want to keep busy as long as I am able. A nice % of the primary care physicians I know are working into and beyond 70. As long as you are healthy and in good shape, why the hell not?

Also you might consider subspecialties like endo, rheum, even hem/oncology. Residency and fellowship may be grueling. But private practice much more palatable. Regular hours, etc.

 

[doc05]

"Overnights" happen throughout the 3rd and 4th years of med school and intern year. You've got to get through 5 years of training, not on your terms, to get to where your less strenuous specialty choice is any less strenuous.

Nobody is particularly fond of the hours, whether you're 21 or 51. It's just part of the game. The 21 year olds are just as wrecked post-call as I am at 49. Work ethic matters a lot more than age.

Trying to pick a low impact specialty as a premed because you're worried about being older makes less sense than considering whether medicine is really the best choice vs. other career choices. Dentists, PTs, etc have as much autonomy and income as MD or DO, with far shorter training and far fewer lost income years. Take a look at ramusa.org and see if you still think being a physician is the most helpful and impactful health care career.

Basically if you're worried now about having enough energy to keep up with the kiddoes, that's a bad sign. The endlessness of med school and residency, the loss of other opportunities, the loss of the highest yield investment years of your life, the strain on relationships, the debt - these issues are what you really ought to worry about. Low energy or feeling your age will just make it more likely that you don't make it through pre-clinical years, much less the call schedule of 3rd year.

Best of luck to you.

I have no idea where you are in terms of career, but having completed many long years of surgical training, I can tell you I would never want to start the process as an older resident. it's too much crap to put up with, and that's not just the physical stress

 

[jl lin]

Also you might consider subspecialties like endo, rheum, even hem/oncology. Residency and fellowship may be grueling. But private practice much more palatable. Regular hours, etc.

Yes, well, I have to get in first. FM seems good; but I really enjoy working with peds, and I fear I won't get enough pediatric patients in FM. Sure it will vary, depending on if you are working out in East Jabip or not. Keeping an open mind, however, within reason.

Surgery is a hugely tough specialty based on what I've seen, been around. So much so that even if I were 2o something, I'd probably try for something else. Much respect to that role; but it's not for me. I am outgoing enough. It's just so much BS and just really tiring, constantly demanding work--especially through training. God, I don't know how some of those folks have lives during their training. I know they do. Plenty start families, but it's really a grind. I think you really have to want to eat, sleep, and drink it. And that's awesome. We will always need great surgeons--always. I just want a little more balance in my life.

I like interacting with patients and families too. Surgeons do that, but it always seems like they don't have a lot of time for that, most of the time--least not during training. I haven't seen a lot of chubby surgeons--a few, but not many. Run, run, run--move, move, move. 🙂 Efficient little devils. 😉

 

[DrMidlife]

I have no idea where you are in terms of career, but having completed many long years of surgical training, I can tell you I would never want to start the process as an older resident. it's too much crap to put up with, and that's not just the physical stress

the OP has no interest in a strenuous specialty. my point was that if you know beforehand that you don't want the hours and crap of a strenuous residency, then it would be smart to reconsider med school entirely.

yes, i understand the crapload of crap in a surg residency (and am not interested in going that direction, personally). the pain of a surg residency is the NFL; it's not clear that the OP is up for Pop Warner ball. The comparatively smaller crapload of crap in med school and intern year is still a destabilizing amount of crap.

 

[bashwell]

Yes, well, I have to get in first. FM seems good; but I really enjoy working with peds, and I fear I won't get enough pediatric patients in FM. Sure it will vary, depending on if you are working out in East Jabip or not. Keeping an open mind, however, within reason.

Surgery is a hugely tough specialty based on what I've seen, been around. So much so that even if I were 2o something, I'd probably try for something else. Much respect to that role; but it's not for me. I am outgoing enough. It's just so much BS and just really tiring, constantly demanding work--especially through training. God, I don't know how some of those folks have lives during their training. I know they do. Plenty start families, but it's really a grind. I think you really have to want to eat, sleep, and drink it. And that's awesome. We will always need great surgeons--always. I just want a little more balance in my life.

I like interacting with patients and families too. Surgeons do that, but it always seems like they don't have a lot of time for that, most of the time--least not during training. I haven't seen a lot of chubby surgeons--a few, but not many. Run, run, run--move, move, move. 🙂 Efficient little devils. 😉

I think peds can be a good lifestyle career. I have a couple of friends, one who just finished up a peds residency and the other soon will. The one who finished is working a regular 40 ish hour job and making just under $200k but it should be a lot higher after partnership. She lives in SoCal too. The other friend is already getting good offers.

Yeah I'd never do gen surgery. Maybe something like urology although they still have to do gen surg in their training, or ophtho.

 

[jl lin]

the OP has no interest in a strenuous specialty. my point was that if you know beforehand that you don't want the hours and crap of a strenuous residency, then it would be smart to reconsider med school entirely.

yes, i understand the crapload of crap in a surg residency (and am not interested in going that direction, personally). the pain of a surg residency is the NFL; it's not clear that the OP is up for Pop Warner ball. The comparatively smaller crapload of crap in med school and intern year is still a destabilizing amount of crap.

True, but most people that get in can suck that part up. It's the prolonged sucking it up of a surgical residency that is tough. Yes. Superbowl kind of stuff. Nick Naylor just shared that his intern year may be about 60 hours/ wk on average. Is this FM? Don't know. Hell, I've easily worked over 70 hours--the uneasy part was scheduling classes for the way the hours worked and crappy reimbursement when you put all things into consideration. But during residency, it's a learning program + a stipend, so like I Said in the other thread, dividing out the hours and comparing them to nurses' salaries doesn't work and makes no sense. My point though is that I can suck it up for 4 years post MS, b/c I have been sucking a lot up already. Don't know about the OP. Your point about the training taking a toll is certainly true; but IMHO, it's still not as painful as surgery--or OBGYN.

 

[jl lin]

I think peds can be a good lifestyle career. I have a couple of friends, one who just finished up a peds residency and the other soon will. The one who finished is working a regular 40 ish hour job and making just under $200k but it should be a lot higher after partnership. She lives in SoCal too. The other friend is already getting good offers.

Yeah I'd never do gen surgery. Maybe something like urology although they still have to do gen surg in their training, or ophtho.

Here's my dilemma: I like working with both pediatric patients and adults patients, and I have a lot of experience working with both.
My fear w/ IM/PEDS is the IM part--and Dr ML is right. IM can be butt-kicking too; plus I won't get as much outpatient training as compared with say FM. I don't think (really don't know) if there are any FM residencies that can move to pediatric fellowship. I really don't think there is. I've seen a FM w/ ED fellowship (no board cert in the ED obviously) but I think ultimately I would have to do a pediatric residency or an IM/Peds residency program. The IM Is going to hurt, no doubt.

 

[Nasrudin]

DrML has a great point. Deciding on medicine knowing a ton of work is the ante for sitting at the table of even deciding on a specialty is step 1. Step 2 is the step 1--the benchmark of your relative competitiveness. You don't even consider derm an option until you've arm barred early medical school in the first round, putting the rest of medical on notice that the champion is coming for them. Step 3 you try on your first 24-30 hours surgery or OB call, and try to realize that gophering as a medical student doesn't touch the output of a resident doing the work. Step 4 is weigh out all the other likesies and dislikesies. Step 5 is you choose a field.

You can mess around as a premed. Talking about what you might do. Kind of like how I was certain I would be a cowboy when I was 3. Pointing to my red cowboy boots as proof.

Before you even begin to start at step 1. You, of course, have to get a seat in medical school.

Just in this little tiny corner of sdn, I've seen countless yappers who pass through and are never seen again.

 

[koikisi]

"Overnights" happen throughout the 3rd and 4th years of med school and intern year. You've got to get through 5 years of training, not on your terms, to get to where your less strenuous specialty choice is any less strenuous.

Nobody is particularly fond of the hours, whether you're 21 or 51. It's just part of the game. The 21 year olds are just as wrecked post-call as I am at 49. Work ethic matters a lot more than age.

Trying to pick a low impact specialty as a premed because you're worried about being older makes less sense than considering whether medicine is really the best choice vs. other career choices. Dentists, PTs, etc have as much autonomy and income as MD or DO, with far shorter training and far fewer lost income years. Take a look at ramusa.org and see if you still think being a physician is the most helpful and impactful health care career.

Basically if you're worried now about having enough energy to keep up with the kiddoes, that's a bad sign. The endlessness of med school and residency, the loss of other opportunities, the loss of the highest yield investment years of your life, the strain on relationships, the debt - these issues are what you really ought to worry about. Low energy or feeling your age will just make it more likely that you don't make it through pre-clinical years, much less the call schedule of 3rd year.

Best of luck to you.

You nailed it! I hate the notion that the twenty year olds can do a better job than us classics. Honestly most of them seem so drunk with their hangovers and all those parties they have that they seem like a havoc to the nurses station more than anything.