Can't Decide on Specialty, Help!

[SignOftheTiger]

So for the past few months I have been trying to decide what specialty to pursue and I've been stuck between family medicine, pediatrics and internal medicine. I have rotated through all of them so far and only have ob/gyn and psych left (both of which I don't have any interest in).

If I go into internal medicine, I most likely will not specialize. I really enjoy the outpatient setting and am fairly certain that I would like to do primary care as I am not fond of inpatient medicine. My issue with this is that internal medicine residency is a lot of inpatient medicine. I'm looking into programs with a primary care track, but not every program has this and if they do, it's only slightly more outpatient time, if I'm not mistaken.

For peds, I really enjoyed both the inpatient and outpatient experience however, my outpatient experience was limited (7 days) and had a skewed patient population (very young kids, mostly 4-12 month well child checks, which got super boring for me....)

I also really enjoyed my family medicine clerkship, but I never saw any kids. Also, my hesitancy about doing this specialty, despite it being more outpatient focused (which I like) is that the training is so broad and it seems like if I ultimately want to practice in a urban/suburban environment that being a family physician wouldn't make any sense and that I should just do peds or just do internal. (I DO NOT want to do med/peds).

I wish I had these "Aha!" moments some of my classmates are experiencing, but I haven't and would like some advice or any input on how I can try and choose what to go in to. Thanks guys!

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[Stellar Clouds]

it seems like if I ultimately want to practice in a urban/suburban environment that being a family physician wouldn't make any sense

Please expand more on this point, I don't quite understand it. It seems from your post that family medicine would be the best fit for you, until I read this line which doesn't really make any sense to me.

 

[username456789]

Please expand more on this point, I don't quite understand it. It seems from your post that family medicine would be the best fit for you, until I read this line which doesn't really make any sense to me.

I assume it's alluding to the fact that family physicians in more rural/less population dense areas get to "do more" due to lack of support by other specialists and hospital systems nearby. If you want to be "the doctor" for your area (and many people going into FM do want that role), it won't work as well in a crowded area with lots of other doctors/specialists.

 

[Stellar Clouds]

I assume it's alluding to the fact that family physicians in more rural/less population dense areas get to "do more" due to lack of support by other specialists and hospital systems nearby. If you want to be "the doctor" for your area (and many people going into FM do want that role), it won't work as well in a crowded area with lots of other doctors/specialists.

I understand the point you are making, but if he wants to work in a suburban/urban area, it won't make one difference whether he is FM or IM if his goal is to work primary care.

 

[SignOftheTiger]

GuyWhoDoesStuff explained what I meant exactly. It would seem pointless to train in a field that is supposed to prepare you to be "the only doctor around" when I plan on practicing in areas with many other doctors/specialists in close proximity. I would rather be a physician for just adults and be very familiar with the issues they have or just for children and be an expert in general pediatric problems instead. The appeal of family to me was the focus on more outpatient training since I know I ultimately want to practice in an outpatient setting.

 

[colbgw02]

GuyWhoDoesStuff explained what I meant exactly. It would seem pointless to train in a field that is supposed to prepare you to be "the only doctor around" when I plan on practicing in areas with many other doctors/specialists in close proximity. I would rather be a physician for just adults and be very familiar with the issues they have or just for children and be an expert in general pediatric problems instead. The appeal of family to me was the focus on more outpatient training since I know I ultimately want to practice in an outpatient setting.

It's pretty easy to be an adults-only family practitioner, particularly if you intend on working in an urban environment. And it's not like you'll become some amazing generalist for adults if you do IM that you otherwise would have missed out on by doing FM. If you intend to practice primarily or exclusively outpatient medicine, then I don't think you gain much at all by focusing on adults (IM) or children (peds), especially if an inpatient-heavy residency irks you. Minus a few surgery, OB, and peds rotations, FM sounds nearly tailor-made for what you're describing.

 

[evilbooyaa]

Doing a FM residency doesn't mean you have to see adults and kids as part of your practice.

FM residencies also have an in-hospital component (although they do have significantly more clinic compared to IM residents), so it's not all daisies.

All that being said, I think FM is your best bet if you want your residency to be outside of the hospital.

 

[joker2400]

What about the IM residencies with a primary care track?