Best suited residency for the dispassionate grad

[dazedundco]

Hey ya'll, this is another thread about yet another confused guy trying to figure out his direction. (BTW, I'm not American).

Long story short,
I immensely enjoyed med school, studied my hardest and got to the top of my class. However, during my internship (in both medical and surgical wards), I came to realize that I don't find the daily job interesting or rewarding, that I don't see where I fit and have no motivation or passion towards any specialty.
As of yet I am not ready to give up on clinical medicine by either specializing in non-clinical specialties or going to a different field. I would rather to give it a try first than give up and wonder years down the road whether it was the right choice.

Shortly about myself - I admire the surgical fields and find surgery exciting, but am not the surgeon type. I am shy, insecure, laid back and prefer non-stressful environments. Ophto/Derma suit me on paper the most. I am not lazy or afraid of hard work, I'm just more of the scholar hippie type of person who loves goofing around with other people. I'm not quick to react, not technical and love using my mind as well as my hands in gentle/sensitive procedures or operations. In general I prefer not to neglect my hobbies, family and life goals unrelated to medicine. As far as we humans know, we get to live only once and there's so much to see, do and experience outside work. I would prefer not to operate or see volume of patients till late evening just to make more money.
When it comes to non-surgical specialties, I lean the most towards Peds / FM, although I honestly hate the endless-rounding and novels worth of documentation / followups associated with these specialties. I have ruled out IM, Radiology, Psychiatry, Anesthesiology, PM&R, I have no special interest in glorious fellows such as cardio or GI.

My question is, since I don't have any particular interest in any residency, should I pursue the least demanding and non-surgical specialty (like FM), or should I try my luck in any of the surgical subspecialties? To see in either case if something grows on me or then rethink my future in medicine.
I mean no disrespect towards any specialty, I'm just desperate to find my way and set my foot in medicine.

Hope I kept it as short as possible.
Thanks for your help in advance

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[GoSpursGo]

(BTW, I'm not American).

Quick question first--is your intent to train/practice in the US? Because if yes, then you have a long road ahead of you, and it would be very unlikely that you could attain a surgical subspecialty residency almost no matter what you do.

If you're just asking philosophically about what kind of specialty suits you best, we may be able to help you more.

 

[SunBakedTrash]

It sounds like you might actually like pathology. With record low numbers of AMGs, it’s easier than ever to stand out for jobs if you are a competitive applicant. Sure it has it’s issues, any small hospital based specialty does ( see rad onc) but it’s lifestyle friendly, no patients, no notes, no rounding, decent paying, good for those who liked the first two years of med school more than the last two, and interfaces often with surgery and surgical procedures. As long as you know you’ll be a big fish, it’s a great field.

 

[dazedundco]

Quick question first--is your intent to train/practice in the US? Because if yes, then you have a long road ahead of you, and it would be very unlikely that you could attain a surgical subspecialty residency almost no matter what you do.

If you're just asking philosophically about what kind of specialty suits you best, we may be able to help you more.

As of now I do not plan on practicing in the US, although I did take the STEPs. Outside the US I do have fair shot of getting a spot in some of the surgical subspecialties

 

[Dral]

It sounds like you might actually like pathology. With record low numbers of AMGs, it’s easier than ever to stand out for jobs if you are a competitive applicant. Sure it has it’s issues, any small hospital based specialty does ( see rad onc) but it’s lifestyle friendly, no patients, no notes, no rounding, decent paying, good for those who liked the first two years of med school more than the last two, and interfaces often with surgery and surgical procedures. As long as you know you’ll be a big fish, it’s a great field.

This was my thought as well. You don't get a ton of interactions with others (and even less with patients). I do Derm/Dermpath and I have gravitated more toward dermpath for some of the reasons you (OP) mentioned. I do still like derm and really enjoy patient interactions, but the cerebral part of dermpath is fun to me.

 

[Iamnew2]

Hey ya'll, this is another thread about yet another confused guy trying to figure out his direction. (BTW, I'm not American).

Long story short,
I immensely enjoyed med school, studied my hardest and got to the top of my class. However, during my internship (in both medical and surgical wards), I came to realize that I don't find the daily job interesting or rewarding, that I don't see where I fit and have no motivation or passion towards any specialty.
As of yet I am not ready to give up on clinical medicine by either specializing in non-clinical specialties or going to a different field. I would rather to give it a try first than give up and wonder years down the road whether it was the right choice.

Shortly about myself - I admire the surgical fields and find surgery exciting, but am not the surgeon type. I am shy, insecure, laid back and prefer non-stressful environments. Ophto/Derma suit me on paper the most. I am not lazy or afraid of hard work, I'm just more of the scholar hippie type of person who loves goofing around with other people. I'm not quick to react, not technical and love using my mind as well as my hands in gentle/sensitive procedures or operations. In general I prefer not to neglect my hobbies, family and life goals unrelated to medicine. As far as we humans know, we get to live only once and there's so much to see, do and experience outside work. I would prefer not to operate or see volume of patients till late evening just to make more money.
When it comes to non-surgical specialties, I lean the most towards Peds / FM, although I honestly hate the endless-rounding and novels worth of documentation / followups associated with these specialties. I have ruled out IM, Radiology, Psychiatry, Anesthesiology, PM&R, I have no special interest in glorious fellows such as cardio or GI.

My question is, since I don't have any particular interest in any residency, should I pursue the least demanding and non-surgical specialty (like FM), or should I try my luck in any of the surgical subspecialties? To see in either case if something grows on me or then rethink my future in medicine.
I mean no disrespect towards any specialty, I'm just desperate to find my way and set my foot in medicine.

Hope I kept it as short as possible.
Thanks for your help in advance

Surgery to any extent is hard core and stressful. If you want laid back and hippie I would say that surgery is not the way to go. Preventive med? Genetics? Genetics has lots of intellectual stimulation I would assume trying to figure out genetic anomalies, testing, etc. I would imagine it's laid back and you are ot seeing 50 patients a day. Wound care?

 

[NotAProgDirector]

Interventional radiology? I know you "ruled out" radiology, but IR offers relatively low stress procedures

 

[Apollyon]

Interventional radiology? I know you "ruled out" radiology, but IR offers relatively low stress procedures

Maybe it has changed, but, friend of mine that is rads told me that any subspecialty rads jobs still have to do general rads, too, because there's just not enough if you are IR, a mammographer, neurorads, body CT, or whatever.

 

[Iamnew2]

Maybe it has changed, but, friend of mine that is rads told me that any subspecialty rads jobs still have to do general rads, too, because there's just not enough if you are IR, a mammographer, neurorads, body CT, or whatever.

This is true. Additionally IR can be very stressful. As you point out, most interventional IR peeps also take general rads call which can be very stressful and unpredictable. Mammorgraphy is chill, but fellowhpi is competitive, there is high liability given the subject matter of breast cancer. Also you have to get through radiology resdiency which can be stressful.

 

[hmockingbird]

I feel like Derm would be a good option with the opportunity for Dermpath if you decide you’d rather have less clinical interactions and MOHS if you wanted to dig into the surgical side.

 

[PTPoeny]

You say you like Peds and FM but not rounding, novel length notes and follow-up. Have you done much outpatient work? I don't know how your internship is set up, but I know in my intern year we didn't spend much time outpatient and it seems like you might prefer it.

Again, I don't know the system in your country but I have plenty of friends working outpatient primary care who work 3.5 days a week and have plenty of time to balance hobbies/family. Peds especially, most of the kids are healthy and don't require novels of notes and the follow-up is usually let's see how much baby has grown in 2 months. Obviously sometimes it is more than that.

 

[Iamnew2]

I feel like Derm would be a good option with the opportunity for Dermpath if you decide you’d rather have less clinical interactions and MOHS if you wanted to dig into the surgical side.

Right, because just randomly deciding to do derm and matching in derm is so easy. Sorry but derm is probably the most challenging residency to match into, and probably next to impossible without years of planning.

It's kind of like waking up one morning and saying, oh I'm going to become a billionaire like Jeff Bezos. Easier said than done.

 

[dazedundco]

First off thank you all for taking the time to reply.

- As for surgery, I'm well aware of the fact that these specialties are stressful and hardcore (but some shifts in IM or Neurology wards can get stressful and hardcore no less). In that post however I wanted to place more emphasis about me not being the best fit to subspecialties located at the higher end of the spectrum when it comes to emergencies/high acuity cases (OB/GYN, Gen surg, etc).

- Within the realm of clinical medicine, I do enjoy having interactions with patients and being able to help them out directly. That's why I never considered Pathology and Radiology. It's the medical practice and routine itself that lost its charm on me, not the humane/social aspect of practicing medicine.
I think that not having patients of my own with some kind of continuity of care will bother me.

- I know Dermatology has the best "prospects" among the specialties, but unfortunately, as mentioned above and is well known, it's extremely hard to get into it (no matter where you live), so I'm looking more into the less competitive specialties.

- PTPoeny, you're absolutely right, I have almost zero experience with outpatient peds and I heard that in outpatient settings you can tailor your practice to grant you a good lifestyle. But that's also relevant to many other specialties, even to the surgical ones. What happens after residency is your own thing.
I found inpatient peds to be utterly boring, although I immensely enjoyed having the pediatric population as my patients (over the oldies in IM) and loved the ambiante in children hospitals.
I chose FM and Peds since these are broad internal fields, less competitive, with a variety of fellowships to consider (where I live there aren't combined programs such as medpeds / IM-Peds)

Again I'm not "in" for any specialty out of the right reasons. In general I find surgery way more interesting, exciting and rewarding than medicine.
Question is whether I should try and get into a surgical specialty regardless of my non-surgeon character (and I know surgeons, worked with them a lot) and lifestyle ambitions, or am I being naive and should focus myself on getting into a relatively easier/the "easiest" medical specialty that could remotely interest me (FM/Peds etc) and hope it grows on me and pulls me back into the game.

 

[Dr.LeoSpaceman]

First off thank you all for taking the time to reply.

- As for surgery, I'm well aware of the fact that these specialties are stressful and hardcore (but some shifts in IM or Neurology wards can get stressful and hardcore no less). In that post however I wanted to place more emphasis about me not being the best fit to subspecialties located at the higher end of the spectrum when it comes to emergencies/high acuity cases (OB/GYN, Gen surg, etc).

- Within the realm of clinical medicine, I do enjoy having interactions with patients and being able to help them out directly. That's why I never considered Pathology and Radiology. It's the medical practice and routine itself that lost its charm on me, not the humane/social aspect of practicing medicine.
I think that not having patients of my own with some kind of continuity of care will bother me.

- I know Dermatology has the best "prospects" among the specialties, but unfortunately, as mentioned above and is well known, it's extremely hard to get into it (no matter where you live), so I'm looking more into the less competitive specialties.

- PTPoeny, you're absolutely right, I have almost zero experience with outpatient peds and I heard that in outpatient settings you can tailor your practice to grant you a good lifestyle. But that's also relevant to many other specialties, even to the surgical ones. What happens after residency is your own thing.
I found inpatient peds to be utterly boring, although I immensely enjoyed having the pediatric population as my patients (over the oldies in IM) and loved the ambiante in children hospitals.
I chose FM and Peds since these are broad internal fields, less competitive, with a variety of fellowships to consider (where I live there aren't combined programs such as medpeds / IM-Peds)

Again I'm not "in" for any specialty out of the right reasons. In general I find surgery way more interesting, exciting and rewarding than medicine.
Question is whether I should try and get into a surgical specialty regardless of my non-surgeon character (and I know surgeons, worked with them a lot) and lifestyle ambitions, or am I being naive and should focus myself on getting into a relatively easier/the "easiest" medical specialty that could remotely interest me (FM/Peds etc) and hope it grows on me and pulls me back into the game.

If you can get into a surgical specialty and make it through training, you could certainly develop a practice that fits your personality. But those still may represent significant hurdles.

I don't know much about it specifically, but honestly something like wound care might work for you. And you wouldn't be limited to getting there through surgical specialities (or completing any specific residency, for that matter). There was even an SDN blog post on this a few months ago.

 

[Chads2]

Anesthesia and then possibly pain medicine.

There’s s enough procedural aspects of anesthesia to keep things interesting for you. You interact with patients but only in limited blocks and you don’t deal with the soul crushing aspects of medicine like insurance and social concerns. Your friendly, hippie self will enjoy the OR environment with the operating team except for the surgeon. .

And then if you do pain fellowship, you’ll be able to have an outpatient life with some procedures with some pretty immediate sat

 

[NRAI2001]

I think the OP is basically asking what is the laziest specialty you can get into essentially for burn outs???

I would say psych?? Serious though.. burn out exists. Most of my friends class mates that seemed burnt out of just not as passionate as they start off with went into psych. They work 4-5 days a week and leave for home by 2-3pm most days and make closer to $300k doing this... but they seem so dispassionate about their field.

Personally I think FM is really blossoming as a lifestyle field. About half of my FM class got jobs working 4 days a week, no call, seeing upto 15 patients a day and make over $200k a year doing this. I opted for an RVU based job and I push myself to work harder, but I plan to go to 4 days a week myself in a few years.

 

[Dave1980]

Interventional radiology? I know you "ruled out" radiology, but IR offers relatively low stress procedures

lol not where ive practiced. IR is hardcore.

 

[Dave1980]

scholar hippie type of person

never heard of this trope before. sounds like a millenial thing

 

[LucidSplash]

never heard of this trope before. sounds like a millenial thing

Remember, millenials are mostly in their 30s now, nearing 40s. Maybe you mean gen Z.

As a Xennial, I think scholar-hippies used to just be known as nerds with beards.

 

[agranulocytosis]

Every speciality has "endless" documentation. It comes from appeasing the payors (read: insurance companies). Surgeons have op notes, pre-op H&Ps, and the god-awful $hitty hours etc.

I believe FM has the most options in terms of variability in practice. One of my FM-trained med school classmates is a cosmetologist (Botox Doc) making bank. Others are rural FM docs that can do appendectomies if needed. Another is a boutique-style doc that takes cash-only patients for unnecessary on-demand testing and oxygen therapy.

You can also do a 1-year internship in FM, IM, EM, whatever you choose and be a cruise ship doc working the seas. Or a prison doc. Whatever you want.

 

[agranulocytosis]

lol not where ive practiced. IR is hardcore.

IR can do hardcore procedures, but they generally don't do hardcore management. Complications are managed by critical care or surgeons. The routine follow-ups are generally done by subspecialists like GI, Pulm, Cards, etc.

We all look to IR like they've got it good.

 

[Dave1980]

IR can do hardcore procedures, but they generally don't do hardcore management. Complications are managed by critical care or surgeons. The routine follow-ups are generally done by subspecialists like GI, Pulm, Cards, etc.

We all look to IR like they've got it good.

believe me they dont have it good. they get dumped on super hard in most places ive trained and worked.

 

[ThoracicGuy]

Every speciality has "endless" documentation. It comes from appeasing the payors (read: insurance companies). Surgeons have op notes, pre-op H&Ps, and the god-awful $hitty hours etc.

I believe FM has the most options in terms of variability in practice. One of my FM-trained med school classmates is a cosmetologist (Botox Doc) making bank. Others are rural FM docs that can do appendectomies if needed. Another is a boutique-style doc that takes cash-only patients for unnecessary on-demand testing and oxygen therapy.

You can also do a 1-year internship in FM, IM, EM, whatever you choose and be a cruise ship doc working the seas. Or a prison doc. Whatever you want.

While it is possible to do 1 year as a US grad and then get a job, that is not an option I would ever recommend. Your options will be greatly limited by only doing one year and you're not going to do as good of job as the doctor that finished their residency training.

 

[gutonc]

First off thank you all for taking the time to reply.

- As for surgery, I'm well aware of the fact that these specialties are stressful and hardcore (but some shifts in IM or Neurology wards can get stressful and hardcore no less). In that post however I wanted to place more emphasis about me not being the best fit to subspecialties located at the higher end of the spectrum when it comes to emergencies/high acuity cases (OB/GYN, Gen surg, etc).

- Within the realm of clinical medicine, I do enjoy having interactions with patients and being able to help them out directly. That's why I never considered Pathology and Radiology. It's the medical practice and routine itself that lost its charm on me, not the humane/social aspect of practicing medicine.
I think that not having patients of my own with some kind of continuity of care will bother me.

- I know Dermatology has the best "prospects" among the specialties, but unfortunately, as mentioned above and is well known, it's extremely hard to get into it (no matter where you live), so I'm looking more into the less competitive specialties.

- PTPoeny, you're absolutely right, I have almost zero experience with outpatient peds and I heard that in outpatient settings you can tailor your practice to grant you a good lifestyle. But that's also relevant to many other specialties, even to the surgical ones. What happens after residency is your own thing.
I found inpatient peds to be utterly boring, although I immensely enjoyed having the pediatric population as my patients (over the oldies in IM) and loved the ambiante in children hospitals.
I chose FM and Peds since these are broad internal fields, less competitive, with a variety of fellowships to consider (where I live there aren't combined programs such as medpeds / IM-Peds)

Again I'm not "in" for any specialty out of the right reasons. In general I find surgery way more interesting, exciting and rewarding than medicine.
Question is whether I should try and get into a surgical specialty regardless of my non-surgeon character (and I know surgeons, worked with them a lot) and lifestyle ambitions, or am I being naive and should focus myself on getting into a relatively easier/the "easiest" medical specialty that could remotely interest me (FM/Peds etc) and hope it grows on me and pulls me back into the game.

So, since we don't know where (outside of the US) you are, it may be hard to give you particularly useful information. But in the US at least (which, again, may or may not be relevant to you), I would steer someone like yourself to either FM or IM.

FM - Broad, mostly outpatient, training with a wide variety of practice options after training. PCP, UC, Rural everything-ist, DPC, Boutique BS that pays bank in cash...etc.

IM - Adult primary care, hospitalist or a wealth of sub-specialty opportunities if you find something that interests you during training.

I would not suggest a surgical sub-specialty unless you're driven for it. Surgery is hard. Even a lot of people who love it wind up bailing for something else during residency.

 

[agranulocytosis]

While it is possible to do 1 year as a US grad and then get a job, that is not an option I would ever recommend. Your options will be greatly limited by only doing one year and you're not going to do as good of job as the doctor that finished their residency training.

Agreed, just giving options. Some options are worse than others.

 

[agranulocytosis]

believe me they dont have it good. they get dumped on super hard in most places ive trained and worked.

I understand. The 6pm consult for EKOS for submassive or massive PE, the 8pm retroperitoneal bleed, the 1am GI bleeder that surgery won’t touch, the 3am large vessel MCA branch occlusion, you guys get smoked.

But the reality is that we all get smoked.

Whether it’s being procedurally dumped on or being killed in managing the course of the patient, it’s all the same. Stress is stress. The reality is IR is never the primary for these patients. Someone is requesting IR for intervention.

As a Pulm Crit, I see it from all sides. Inpatient, outpatient, crashing, elective, etc. IR is indispensable in the management for our patients. But when it comes time to decide on when to pull the Pleur-X you placed for malignant effusion or remove the pigtail for pneumothorax you placed, we decide on that and pull them accordingly.

We also decide on whether to call you or not. In PP that means RVUs.

Everyone gets smoked. I just think you have it good bc you don’t have to deal with management.

 

[Bobbbyyyy]

First off thank you all for taking the time to reply.

- As for surgery, I'm well aware of the fact that these specialties are stressful and hardcore (but some shifts in IM or Neurology wards can get stressful and hardcore no less). In that post however I wanted to place more emphasis about me not being the best fit to subspecialties located at the higher end of the spectrum when it comes to emergencies/high acuity cases (OB/GYN, Gen surg, etc).

- Within the realm of clinical medicine, I do enjoy having interactions with patients and being able to help them out directly. That's why I never considered Pathology and Radiology. It's the medical practice and routine itself that lost its charm on me, not the humane/social aspect of practicing medicine.
I think that not having patients of my own with some kind of continuity of care will bother me.

- I know Dermatology has the best "prospects" among the specialties, but unfortunately, as mentioned above and is well known, it's extremely hard to get into it (no matter where you live), so I'm looking more into the less competitive specialties.

- PTPoeny, you're absolutely right, I have almost zero experience with outpatient peds and I heard that in outpatient settings you can tailor your practice to grant you a good lifestyle. But that's also relevant to many other specialties, even to the surgical ones. What happens after residency is your own thing.
I found inpatient peds to be utterly boring, although I immensely enjoyed having the pediatric population as my patients (over the oldies in IM) and loved the ambiante in children hospitals.
I chose FM and Peds since these are broad internal fields, less competitive, with a variety of fellowships to consider (where I live there aren't combined programs such as medpeds / IM-Peds)

Again I'm not "in" for any specialty out of the right reasons. In general I find surgery way more interesting, exciting and rewarding than medicine.
Question is whether I should try and get into a surgical specialty regardless of my non-surgeon character (and I know surgeons, worked with them a lot) and lifestyle ambitions, or am I being naive and should focus myself on getting into a relatively easier/the "easiest" medical specialty that could remotely interest me (FM/Peds etc) and hope it grows on me and pulls me back into the game.

You might find ENT very interesting. But then again, it is pretty competitive.