Best specialty for the burnt out, jaded 3rd year who has little passion left for medicine

[NSxortho]

Canadian MD student so we don’t do any of the steps.

If you look at my previous posts, I was a hardcore ortho vs neurosurg gunner for the first 3 years. I’ve done as much exploring, shadowing and have completed all of my rotations at this point.

I went through ortho just before 4th year electives and realized I was becoming more and more unhappy every day. The aggressive culture, the slavery, 1 in 4 call + staying post-call showed me that’s no way to live for me. As much as I enjoy operating and was well liked by the staff and residents, I think I’ll be unhappy in an ortho residency.

Just before 4th year electives I decided to take a year off because I couldn’t imagine myself doing ortho and I was heavily unsure about doing family or anything else really. I figured that I may still be interested in some other Uber competitive specialty and would need the extra year to make myself competitive.

Things I do love: interacting with patients gives me a lot of joy, and so does operating or procedures. So things like rads and path are out. IM is out because I hate the mental masturbation and eternal rounding. Psyc is out too because I want to fix **** not just talk.

Currently thinking either Derm, PM&R or something surgical/procedural that is not as brutal as ortho. I just want to get out of med school, make good money, talk to patients, be able to help them and make them happy.

There are still days I regret giving up ortho. I really thought it was the dream. But I need to be true to my feelings and do some soul searching before I commit to something for the rest of my life.
Thank you all

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[Angler]

Things I do love: interacting with patients gives me a lot of joy, and so does operating or procedures. So things like rads and path are out. IM is out because I hate the mental masturbation and eternal rounding.

I'm biased because I'm (retired) IM. I'm sure you've thought about IM -> Cards/GI. In practice, especially if non-academic, you don't have endless rounding. And once you've been at it for a short while, you can often be on cruise control; just pattern recognition and do what you're supposed to do without thinking. Of course, during residency, you have no choice but endure some of the nonsense you describe as abhorent.

I admit to a relative lack of knowledge of the Canadian system (though my daughter's SO is a practicing/academic Rads in Alberta and he's taught me a thing or two about the system), so maybe Cards/GI up North is different...

 

[deleted1168269]

Anesthesia seems right up your alley.

Don’t you still have to do Step to match a US residency?

 

[wholeheartedly]

Do you think you’d be happy doing ortho after residency?

 

[NSxortho]

I'm biased because I'm (retired) IM. I'm sure you've thought about IM -> Cards/GI. In practice, especially if non-academic, you don't have endless rounding. And once you've been at it for a short while, you can often be on cruise control; just pattern recognition and do what you're supposed to do without thinking. Of course, during residency, you have no choice but endure some of the nonsense you describe as abhorent.

I admit to a relative lack of knowledge of the Canadian system (though my daughter's SO is a practicing/academic Rads in Alberta and he's taught me a thing or two about the system), so maybe Cards/GI up North is different...

Interesting point! I didn't consider that I could gain confidence and be on cruise control at some point in IM. So, I appreciate that insight. I definitely found the vast amount of knowledge required in IM to be overwhelming. I often felt like it was hard to be competent. I did find the people in IM really warm and a joy to work with in general. Cards and oncology clinics were really good experiences too and very grateful patients. There was definitely a few days when I felt like I could do internal. I'll give it more thought!

Do you think you’d be happy doing ortho after residency?

Yes, I would be. If you told me the residency was shorter or wasn't as brutal, I would do it in a heartbeat. I just feel like I'm tired and burnt out already. I would start residency at 31, and my whole youth would be sacrificed. There Is a lot of things I like outside of medicine and giving it all up during residency would be so depressing. It has been a constant battle. I still don't know what the right move is

Anesthesia seems right up your alley.

Don’t you still have to do Step to match a US residency?

I liked anesthesia! money is good, hours are good, and you get to do stuff. Just couldn't help look over the drape every time in the OR and think to myself that's still more cool. Haven't ruled it out still though! To answer your question, I will be applying to Canadian residency only so will not be writing the Steps.

 

[operaman]

Seconding anesthesia. After awhile nobody cares what’s happening on the other side of the drapes. As a surgeon, I can promise you nobody else in the room gives two craps about what I’m doing other than my ETA til being finished so they can plan their lunches. And there are definitely cases that are plodding along where I’m looking longingly over the drape in the other direction!

In the end it’s still a job, and anesthesia has become a home for many who like the OR but decided surgery wasn’t quite their jam. Stupidly good money and hours with plenty of fellowship option. Interventional Pain guy at my shop consistently banks 1.3-1.5m based on our hospital form 990.

 

[spartan25]

Ophtho

 

[NotAProgDirector]

Interventional Radiology

 

[Dral]

If you want to use your hands and really like talking to people (patients), think about Mohs. It's not easy to get into derm or mohs fellowship, but it's something to think about. During a Mohs repair you have plenty of time to talk with patients. If you do it correctly, your patients will love you for it since you will really get a chance to talk to them and get to know them (which makes them feel valued as a patient).

In my experience, Mohs folks hustle and do a lot of cases. If they do, they can make decent money:

Apparently 2023 MGMA Compensation & Production Report for Mohs is median of $721,777.

 

[solitarius]

Pathology.

Anything non-clinical.

 

[OraclePL]

I second Mohs

 

[LeaveNoTrace]

Consider psych if you don't mind never doing procedures again (except ECT and TMS). You get to do almost nothing but talk to patients; you turn that into an art form in psych. If you're not delusional and thought you had a shot at either neurosurgery or ortho, you're definitely a solid, perhaps even a strong psych applicant. Good luck.

 

[NSxortho]

Seconding anesthesia. After awhile nobody cares what’s happening on the other side of the drapes. As a surgeon, I can promise you nobody else in the room gives two craps about what I’m doing other than my ETA til being finished so they can plan their lunches. And there are definitely cases that are plodding along where I’m looking longingly over the drape in the other direction!

In the end it’s still a job, and anesthesia has become a home for many who like the OR but decided surgery wasn’t quite their jam. Stupidly good money and hours with plenty of fellowship option. Interventional Pain guy at my shop consistently banks 1.3-1.5m based on our hospital from 990.

Would that type salary also be attainable through PM&R through pain fellowship? Probably not as high as a mill but it seems to be lucrative in any field I’m hearing


Regarding the comments about Mohs, I think it aligns a lot with my interests - interacting with patients, doing procedures and seeing generally good outcomes, with a good lifestyle and money. Just a daunting idea to spend a whole year gunning for the most competitive specialty there is in Canada (52% match rate this year)

Consider psych if you don't mind never doing procedures again (except ECT and TMS). You get to do almost nothing but talk to patients; you turn that into an art form in psych. If you're not delusional and thought you had a shot at either neurosurgery or ortho, you're definitely a solid, perhaps even a strong psych applicant. Good luck.

Psyc is cool! I thought it was the most chill rotation I had. Residents and staff all seemed happy. Sadly, I think the lack of procedures is the part I struggle with, but I’ll think about out it more

 

[operaman]

Would that type salary also be attainable through PM&R through pain fellowship? Probably not as high as a mill but it seems to be lucrative in any field I’m hearing


Regarding the comments about Mohs, I think it aligns a lot with my interests - interacting with patients, doing procedures and seeing generally good outcomes, with a good lifestyle and money. Just a daunting idea to spend a whole year gunning for the most competitive specialty there is in Canada (52% match rate this year)

Psyc is cool! I thought it was the most chill rotation I had. Residents and staff all seemed happy. Sadly, I think the lack of procedures is the part I struggle with, but I’ll think about out it more

Good question. Our guy is busy AF and has a super streamlined operation all around. I think he also does his own sedation for the various procedures and is probably billing for that as well as the procedures themselves. It’s kind of like how Mohs folks can bill per section removed, for path, and for any reconstruction - makes fairly simple short procedures generate a lot of revenue.

I’m not sure if PMR is able to bill for both anesthesia/sedation AND the procedure. If they can’t then they would have a harder time hitting those productivity numbers. They can still make a ton of money though in the right setup.

 

[Tenk]

Would fit right into emergency medicine.

 

[Dr G Oogle]

Get an MBA and go work for a VC firm and never look back

 

[deleted1168269]

Would fit right into emergency medicine.

Did you miss the “burnt out” in the title LOL

 

[bGMx]

Consider psych if you don't mind never doing procedures again (except ECT and TMS). You get to do almost nothing but talk to patients; you turn that into an art form in psych. If you're not delusional and thought you had a shot at either neurosurgery or ortho, you're definitely a solid, perhaps even a strong psych applicant. Good luck.

Avoid psychiatry if you don't like: people disagreeing with you, people disrespecting you, not having a clear answer, having to be compassionate all the time with patients, patients seeing you and immediately distrusting you, hearing people's trauma, having to deal with secondary gain, psychology, the human condition, existential suffering, having no solutions, medicine that doesn't work half the time, the idea that people have autonomy separate from your own, restraining people, diplomacy, listening to others, patients targeting you (violently sometimes, though neurology and EM is worse for this). There's probably more. Psychiatry isn't chill unless you are yourself chill.

 

[deleted1162863]

Avoid psychiatry if you don't like: people disagreeing with you, people disrespecting you, not having a clear answer, having to be compassionate all the time with patients, patients seeing you and immediately distrusting you, hearing people's trauma, having to deal with secondary gain, psychology, the human condition, existential suffering, having no solutions, medicine that doesn't work half the time, the idea that people have autonomy separate from your own, restraining people, diplomacy, listening to others, patients targeting you (violently sometimes, though neurology and EM is worse for this). There's probably more. Psychiatry isn't chill unless you are yourself chill.

Why do you say neurology is worse?

 

[NSxortho]

Avoid psychiatry if you don't like: people disagreeing with you, people disrespecting you, not having a clear answer, having to be compassionate all the time with patients, patients seeing you and immediately distrusting you, hearing people's trauma, having to deal with secondary gain, psychology, the human condition, existential suffering, having no solutions, medicine that doesn't work half the time, the idea that people have autonomy separate from your own, restraining people, diplomacy, listening to others, patients targeting you (violently sometimes, though neurology and EM is worse for this). There's probably more. Psychiatry isn't chill unless you are yourself chill.

Yup. now that you mention these, psych is out LOL. I just wanna chat with my patients. Talking to psych patients was exhausting, and having non verbal, super sick ICU and neurosurgery patients was not enjoyable. I really liked ortho and optho patients. I guess I just want them to be kinda normal and healthy lol

 

[bGMx]

Family medicine? You could run a concierge service and once something is outside your comfort, refer out.

 

[SurfingDoctor]

Hospital administrator

Don’t be the recipient of burnout… dish it out instead!

 

[Tenk]

Did you miss the “burnt out” in the title LOL

No. That’s why I said that. He’d fit right in with the rest of us.

 

[NSxortho]

No. That’s why I said that. He’d fit right in with the rest of us.

Is the burn out real? I actually really enjoyed emerg and the sole thing holding me back is the story of burnouts. What gives? Does the shift work and inconsistency really get to you in the long run?

My thought is I could just do 10-12 shifts a month, and just live my life the rest of the month - the idea doesn’t sound bad at all

 

[Tenk]

Is the burn out real? I actually really enjoyed emerg and the sole thing holding me back is the story of burnouts. What gives? Does the shift work and inconsistency really get to you in the long run?

My thought is I could just do 10-12 shifts a month, and just live my life the rest of the month - the idea doesn’t sound bad at all

Eh, it’s not that bad depending on where you work. Working 10 ish shifts a month is definitely doable long term and still nets you a good salary. Circadian dysthymia can get you as you get older though. I wouldn’t pick another specialty just because I am able to increase or decrease my shifts based on how I feel.

 

[DarkHorizon]

Do Ortho. You’ll regret it later. I just finished a brutal week on call, probably worked 70 hours in last 5 days. But I can’t imagine doing anything else.

 

[eyeeye_captain]

I’ll be the second person to put ophtho out there. I do retina, so injections or lasers on around 2/3 of my patients, 3-10 surgeries a week. Plenty of patient contact. Work less than 40 hours a week, call is light. So procedures and a lifestyle that’s less prone to burnout.

From what I can tell, there’s a massive need for ophtho and retina in Canada - the fellowships there get around triple the number of cases of an average program in the US.

 

[ChordaEpiphany]

Get an MBA and go work for a VC firm and never look back

I'm a huge advocate of MDs pivoting to other industries. However, VC is not one of those industries, and anyone casually advocating that someone go into VC is probably naive (i.e., thinks of VC, MC, HF, IB, etc... as one entity titled "business stuff").

MDs completely disillusioned with medicine should look into consulting or investment banking, and they should expect to be competitive at a smaller life sciences-specific firm instead of the top tier firms like MBB (read: 30-50% pay cut). I have friends who've done both from the PhD route and those industries care about only two things: clout and competency. The MD is sufficient clout in most cases (outside of MBB or really prestigious firms). While you likely won't be on the ultra prestige path, you will likely still out earn a physician substantially over your career and work somewhat less.

 

[ChordaEpiphany]

Is the burn out real? I actually really enjoyed emerg and the sole thing holding me back is the story of burnouts. What gives? Does the shift work and inconsistency really get to you in the long run?

My thought is I could just do 10-12 shifts a month, and just live my life the rest of the month - the idea doesn’t sound bad at all

I feel like the issue with this strategy is that you likely get so used to your off time that working becomes torture. Lots of highs and lows in that setup. The happiest people I've met have a consistent routine. Seems like outpatient subspecialty or elective surgery is the best way to achieve this. Specialties like GI, heme-onc, rheum, A&I, PM&R, derm, ophtho, ENT, etc... all seem to produce chill, happy attendings while the ED docs, PCPs, ICU attendings, and high acuity surgeons are decidedly less chill.

 

[Angus Avagadro]

How about taking a research year, decompress, and give it all a fresh look?

 

[percyeye]

Ophtho. Get to do procedures/ surgery. Patients are *typically very happy with outcomes. Good schedule.

 

[phonyreal98]

I'm a huge advocate of MDs pivoting to other industries. However, VC is not one of those industries, and anyone casually advocating that someone go into VC is probably naive (i.e., thinks of VC, MC, HF, IB, etc... as one entity titled "business stuff").

"The business factory"

 

[NSxortho]

I have no interest in going the business route again. I did it prior to med, was in the stocks and insurance business and fully licensed with a well known assurance company. I hated it. Making more than 300K in finance is easily years of work and requires constant studying, public outreach and self marketing. Maybe only 20% of the people I worked with made that much. Anyone who recommends it as an scapegoat to medicine is not fully informed.