Can't figure out what I want to be when I grow up.

[UT_mikie]

I'm sure there are alot of you guys out there that can relate. Every field has something about it I love and a few things that I can't stand.

Medicine - Love the people, love thinking about the pathophys of disease, but won't be curing a damn thing. Hours are crapp, salary is crapp.

Surgery - CV surgery is cool as hell and I love the fellows and all the attendings (interns and residents can suck it), you actually get to cure stuff, but in no way do I think 7 years of misery (residency + fellowship) is worth it to finally be happy and working.

Anesthesia - $$$, hours, OR time ... but I'd like to wear a tie to work. And I know this is layman thinking but somehow I still cringe at the thought of not being considered a real doc.

Peds - Kids are great, but it got really annoying not being able to talk to the patients directly... and I would just get pissed off when some coked up mom is crying and wondering why her malnourished kid is sick and expects me to empathize. Please f--- off and go to hell while I call CPS.

Radiology - $$$, hours, imaging is great, the idea of teleradiology is really attractive (What? I can read in Australia for US hospitals?). Once again, don't cure anything, absolutely 0 patient contact (a neg for me), and most physicians read their own films anyway.

Emergency - Shift work is good ... but I can't tell you how many times I've heard "don't ever trust an ER doctors note... they are absolute crapp." Also, dealing with drug seekers is not so great.

Derm - I once missed a question on an exam ... hence not an option.

Optho - Don't know enough about it, but its a possibility for me. Is it too specialized though?

Path - Seems nice, nice hours, nice people, I wouldn't mind staring at a microscope all day, but no patient contact.

Man, I don't know, I hope I get some perspective by the end of third year, otherwise I'll just be jumping into something and not really knowing if its right for me... Darn.

Any of you guys that are completely smitten by one specialty mind telling me why? I'd love to be talked into something.

---

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[BlackSails]

Since you like both surgery and medicine, you might consider one of the semi-surgical specialties, like optho or ENT.

 

[haveaniceday]

urology is another good one for a mix of surgery and clinic/outpatient procedures...plus training is only 5-6 years depending on where you go. Con: competitive on the level of Derm almost...I think you can maybe miss 2 questions on an exam to get into it

Your post sounds so much like what runs through my head all day, one thing to consider is critical care medicine, you actually do help people and see results (also lots of bad results, too), plus you get the IM training, disease knowledge and hours are usually shift work. Can be more or less training depending on the route you take. pulm/cc is 6 years (3 IM+3 fellowship), or you can do a 1 year CC fellowship and skip the whole pulm research track.

 

[smq123]

Any of you guys that are completely smitten by one specialty mind telling me why? I'd love to be talked into something.

Loved Ob/gyn, very unexpectedly - thinking about doing it. Thought I would hate the messy nature of it, thought I would hate gyn surgery, thought I would hate the hours, thought I would hate the all-female atmosphere.

But I really liked having healthy patients, who have something to celebrate. Loved, loved, loved delivering babies. Every shift on L&D celebrates at least one new birthday. REALLY started to appreciate it after rounding on patients in the MICU/SICU/NICU - patients who are precariously teetering on the edge of death.

Really liked the patients on gyn. Found them to be pretty grateful, for the most part, that you took care of their painful menstrual periods or that you took out a possibly cancerous ovary.

Enjoyed "taking care" of the fathers on L&D. They sometimes need more reassurance than their wives/girlfriends do.

One night, after I saw a patient in the SICU almost code, I swung by L&D for a visit before I left the hospital. Saw someone deliver, and almost started crying - it was such a big difference from what I had seen the hour before.

 

[getunconcsious]

Path - Seems nice, nice hours, nice people, I wouldn't mind staring at a microscope all day, but no patient contact.

K so I am gonna try to talk you into path (just don't steal my spot in residency!). If you already know that you're good at looking at slides and don't mind looking at slides, that alone places you in the minority of people for whom path is an option. You mention under 'medicine' that you love thinking about the PATHophys of disease...well guess what you can do that with 1/2 the hours! In addition, you mention the lack of patient contact as a negative. I could go into a long dissertation on why it is actually a positive, but instead I will point out the opportunities for patient contact that path does offer. In hemepath rotations, you will do bone marrow biopsies (patient contact AND procedure, though granted not a pleasant one). In blood bank/transfusion, you see patients very frequently to give blood products and work up transfusion reactions. Some forensic pathologists consider themselves the 'last physician' to each of their 'patients'. Sounds creepy, but if you think about it the dead patient really is like having a patient b/c they have to do a full work up, not just look at one tissue specimen. Finally, there's pathology's trump card: The lifestyle. Do you really want to do an internship and take q4 call? R1 path peeps don't take in house call and usually don't work more than 12 hours a day. Even 12 hours is rare and limited to difficult rotations like surgical path. I know I don't want to be having to admit someone to the medicine service at 1 am! Why would you? Seriously Mikie think about it.

All that aside, I too am having a *little* trouble deciding to pick path for sure...it just feels so final. My other contenders are peds (like kids), psych (like crazy people) and radiation oncology (like neoplastic disease and the issues unique to CA patients). So I think we're all in the same boat to one degree or another. I'm only about 75% sure I'll end up in path, but you should really give it some thought. I'm glad someone else from our class is considering it!

 

[domer621]

Anesthesia - $$$, hours, OR time ... but I'd like to wear a tie to work. And I know this is layman thinking but somehow I still cringe at the thought of not being considered a real doc.

That's a weird reason to rule out a field.

 

[fakin' the funk]

That's a weird reason to rule out a field.

Not if you're like the OP, and think that the status and image of being a physician (wearing a tie and "being a real doctor") is at least as important as actually delivering medical care.

 

[OddNath]

Not if you're like the OP, and think that the status and image of being a physician (wearing a tie and "being a real doctor") is at least as important as actually delivering medical care.

I think this is fairly common and not all that unreasonable-- I mean we will all end up practicing medicine, but what you end up wearing/how often you get to shower/where you practice/hours are all things that most of us consider at some point.

Personally, I don't know what I want to do yet, either. Thankfully, though, I get an extra 3-4 years to decide, probably between pedi neuro and rads. I like the idea of rads b/c you can be the one to get a really crucial dx-- sure, you're not curing anything, but figuring out what it is can be a hugely important first step.

Mikie have you thought about IR? Or an IM specialty? GI and interventional cards are 2 that come to mind where you really get to go in and fix something without 5 years of general surgery hell.

 

[Thanatos]

I'm sure there are alot of you guys out there that can relate. Every field has something about it I love and a few things that I can't stand.

Medicine - Love the people, love thinking about the pathophys of disease, but won't be curing a damn thing. Hours are crapp, salary is crapp.

Surgery - CV surgery is cool as hell and I love the fellows and all the attendings (interns and residents can suck it), you actually get to cure stuff, but in no way do I think 7 years of misery (residency + fellowship) is worth it to finally be happy and working.

Anesthesia - $$$, hours, OR time ... but I'd like to wear a tie to work. And I know this is layman thinking but somehow I still cringe at the thought of not being considered a real doc.

Peds - Kids are great, but it got really annoying not being able to talk to the patients directly... and I would just get pissed off when some coked up mom is crying and wondering why her malnourished kid is sick and expects me to empathize. Please f--- off and go to hell while I call CPS.

Radiology - $$$, hours, imaging is great, the idea of teleradiology is really attractive (What? I can read in Australia for US hospitals?). Once again, don't cure anything, absolutely 0 patient contact (a neg for me), and most physicians read their own films anyway.

Emergency - Shift work is good ... but I can't tell you how many times I've heard "don't ever trust an ER doctors note... they are absolute crapp." Also, dealing with drug seekers is not so great.

Derm - I once missed a question on an exam ... hence not an option.

Optho - Don't know enough about it, but its a possibility for me. Is it too specialized though?

Path - Seems nice, nice hours, nice people, I wouldn't mind staring at a microscope all day, but no patient contact.

Man, I don't know, I hope I get some perspective by the end of third year, otherwise I'll just be jumping into something and not really knowing if its right for me... Darn.

Any of you guys that are completely smitten by one specialty mind telling me why? I'd love to be talked into something.

Bingo.....surgery is cool. You get enough patient contact to satisfy the people person in you, without the 6 hour interview with an ESRD non-compliant diabetic that covers 1)their favorite type of ice cream and 2)the name of their 5th grade teacher. Plus you get a nice mix of wearing a tie sometimes and wearing pajamas the rest. You get to cure stuff instead of sitting around all day sorting out social issues. Once the patient is sedated, you can tell jokes all day and listen to good music. Variety is a good thing....there are many different procedures done many different ways, not to mention all of the various fellowship options....meanwhile the assessment and plan for runny noses, or coughing, or a bad case of the sh1ts starts to get a little too predictable (the plan for today is to observe, then discharge home). If you ever wonder if surgery is really that cool I have two words for you: argon beam.

Seems like your hold up is the residency....fair enough. Unfortunately residencies in the overwhelming majority of specialties are going to suck....they will involve bad hours, mean people, and call. Medical school isn't exactly pleasant either....you're surviving it now. You can survive a residency also.

 

[153445]

Figure out if you want to cut or not cut. That's a fundamental question that can clear out a lot of options and make things less overwhelming. It sounds like you may like to cut. Just don't put too much stock into what other people's negative perceptions and stereotypes of each specialty are. A lot of doctors in different areas can be really childish and insecure, having to diss other specialties to make themselves feel better or more secure about their own choices. If you get caught up in status or living by what other people think instead of pursuing what you genuinely enjoy, you're going to drive yourself crazy and end up making career choices that you'll probably end up regretting. If you really love your work, you probably won't mind putting in extra time during residency because you'll think what you're doing is pretty friggin' cool.

 

[Arctic Char]

check out this thread i started last year. its funny how similar our thinking is . . . http://forums.studentdoctor.net/showthread.php?t=363510

its also funny to read how my mind worked then and how it has evolved in the last year. not much has changed besides adding pathology to my list of possible futures . . . but man, i'm with you, its just damn hard to make this decision. i am also very strongly considering a transitional year.

anyway, good luck in the journey . . .

 

[UT_mikie]

K so I am gonna try to talk you into path (just don't steal my spot in residency!). If you already know that you're good at looking at slides and don't mind looking at slides, that alone places you in the minority of people for whom path is an option. You mention under 'medicine' that you love thinking about the PATHophys of disease...well guess what you can do that with 1/2 the hours! In addition, you mention the lack of patient contact as a negative. I could go into a long dissertation on why it is actually a positive, but instead I will point out the opportunities for patient contact that path does offer. In hemepath rotations, you will do bone marrow biopsies (patient contact AND procedure, though granted not a pleasant one). In blood bank/transfusion, you see patients very frequently to give blood products and work up transfusion reactions. Some forensic pathologists consider themselves the 'last physician' to each of their 'patients'. Sounds creepy, but if you think about it the dead patient really is like having a patient b/c they have to do a full work up, not just look at one tissue specimen. Finally, there's pathology's trump card: The lifestyle. Do you really want to do an internship and take q4 call? R1 path peeps don't take in house call and usually don't work more than 12 hours a day. Even 12 hours is rare and limited to difficult rotations like surgical path. I know I don't want to be having to admit someone to the medicine service at 1 am! Why would you? Seriously Mikie think about it.

All that aside, I too am having a *little* trouble deciding to pick path for sure...it just feels so final. My other contenders are peds (like kids), psych (like crazy people) and radiation oncology (like neoplastic disease and the issues unique to CA patients). So I think we're all in the same boat to one degree or another. I'm only about 75% sure I'll end up in path, but you should really give it some thought. I'm glad someone else from our class is considering it!

You're back on the path track getunconcious? Last I heard you were gung ho rad/onc. Pathology is attractive, I think one of my favorite parts of LBJ was going to the path labs and having the pathologists explain something to me. It was interesting stuff, and I would always love hearing surgeons say "what? Its 3pm, why are the pathologists gone?"

I don't mind call so much, I didn't feel the Q4 was so bad during my last medicine rotation, I really liked what I was doing, and working patients up with residents was fun. And as long as where I work caps at 2 am, or earlier I'm fine with that. On surgery we would seriously be seeing consults until right before morning rounds. It was ridiculous, I don't think I saw my resident eat once (although she was cool to us tell us to go eat).

Rad/onc seems really cool, as does IR, but I seriously wonder if I got the goods to even consider those, I need to talk to a residency director about all of that.

Hope you had a good thanksgiving getunconcious.

 

[UT_mikie]

That's a weird reason to rule out a field.

I was being facetious. I would never rule anything out simply b/c of dress code, although the honest truth is, that I would rather wear slacks and a tie to work than scrubs for the rest of my life.

 

[UT_mikie]

Figure out if you want to cut or not cut. That's a fundamental question that can clear out a lot of options and make things less overwhelming. It sounds like you may like to cut. Just don't put too much stock into what other people's negative perceptions and stereotypes of each specialty are. A lot of doctors in different areas can be really childish and insecure, having to diss other specialties to make themselves feel better or more secure about their own choices. If you get caught up in status or living by what other people think instead of pursuing what you genuinely enjoy, you're going to drive yourself crazy and end up making career choices that you'll probably end up regretting. If you really love your work, you probably won't mind putting in extra time during residency because you'll think what you're doing is pretty friggin' cool.

Yea, I always hear attendings say "don't decide your career based on how tough a residency will be." While I agree, I don't think 7 years is insignificant. I could deal with 7 years as long as I knew I wouldn't be pushing 100+ hour weeks for the entire time, but that's too much for specialized surgery. I unfortunately don't like cutting that much.

But you give sound advice otherwise. I just need to hash this out, time is ticking away, only about 6 months to go b4 I gotta have some clue.

 

[theOne3]

Radiology - $$$, hours, imaging is great, the idea of teleradiology is really attractive (What? I can read in Australia for US hospitals?). Once again, don't cure anything, absolutely 0 patient contact (a neg for me), and most physicians read their own films anyway.

Just to set the record straight a bit:
1. Diagnosis is the first step to cure. Also, a radiologist can be part of the cure, such as when placing drains ... not to mention vascular interventional procedures.
2. A radiologist does have some patient contact, such as in doing procedures (drains, biopsies, etc). In fact, at the hospital where I'm now working, the body fellows are doing procedures (i.e. seeing patients) every day. It's not as much as in medicine, of course, but really that is a good thing.
3. To say that most physicians read their own films is untrue. Especially in private practice physicians have neither the time nor the willingness to assume the liability. And when physicians do read their own films, this is really limited to plain radiographs.

Good luck in your decision!

 

[getunconcsious]

You're back on the path track getunconcious? Last I heard you were gung ho rad/onc.

LOL, I was NEVER gung-ho radonc. I don't even think I could get it w/o some serious new credentials. Some people (read: someone we'll call "A., MD/PhD", haha) were of the opinion that I "really should go for it!" based on my step 1 score. While I appreciate their enthusiasm, I never lost my obsession with path, it's been my #1 choice since late MS1.

I did have an ok thanksgiving, despite being on call the day before, lol. I hope the same goes for you. Are you on surgery now, or medicine?

 

[TexasTriathlete]

I'm pretty sure trauma surgery is what everyone should want to go into. I've really zeroed in on this in the past few weeks.

Of course, I don't start med school until July, so I could change my mind, but its going to be hard to change my mind from this.

I volunteer at a trauma center right now, and I get fired up when I hear them page a trauma stat. And I don't even do anything. I can only imagine how cool it will be to actually get in there and go to work.

 

[getunconcsious]

I'm pretty sure trauma surgery is what everyone should want to go into. I've really zeroed in on this in the past few weeks.

Of course, I don't start med school until July, so I could change my mind, but its going to be hard to change my mind from this.

I volunteer at a trauma center right now, and I get fired up when I hear them page a trauma stat. And I don't even do anything. I can only imagine how cool it will be to actually get in there and go to work.

Trust me...not everyone is like this. My biggest fear in medicine is acuity, not death. Acute situations basically send me into a panic attack that only benzos could cure. I hope you have a high tolerance for extremely tenuous life-or-death situations!

 

[fakin' the funk]

I'm pretty sure trauma surgery is what everyone should want to go into...Of course, I don't start med school until July, so I could change my mind...I get fired up when I hear them page a trauma stat

You receive today's Award for Unintentionally Hilarious SDN Post

 

[domer621]

You receive today's Award for Unintentionally Hilarious SDN Post

 

[Llenroc]

If you went into medicine with the intention of "curing" people, you're going to be dissapointed no matter what field you go into. The patients have complex diseases, which doctors may be able to treat but not necessarily fix. I can't think of any rotation that I've been on where even 20% of the patients came out healed as a result of the doctor's intervention. Most patients left a little better than when they came in. Some even left worse.

A doctor is hired to provide a service, either giving advice about a medical problem or performing some kind of procedure. If you define your success as the patient being cured by your intervention, then you are setting yourself up for a career of dissapointment. The same goes even if you consider success being whether or not the patient decides to heed your advice.

Either way, I think the ability to effect "cures" should be the last thing you look at when considering a specialty.

 

[Hard24Get]

I was being facetious. I would never rule anything out simply b/c of dress code, although the honest truth is, that I would rather wear slacks and a tie to work than scrubs for the rest of my life.

Based on the fact that you would prefer not to wear scrubs, care about what other docs think of you (bad habit BTW, someone will always think you're an idiot), are annoyed by kids and bad parents, prefer patient contact, prefer good outcomes, and don't like cutting enough to do a surgical residency or work the hours, I think you are left with Medicine, Derm, Optho, and ENT. As a future EM doc (ie, unbiased), allow me to disabuse you of your misconceptions regarding these fields.

Medicine - Love the people, love thinking about the pathophys of disease, but won't be curing a damn thing. Hours are crapp, salary is crapp. Subspecialties like Cardiology or Gastroenterology offer greater salary, better hours, and you can "cure" an arrhythmia via ablation, ischemia via catheterization, or cancer via colonoscopy.

Derm - I once missed a question on an exam ... hence not an option. Cute but of course wrong. And you can match if you apply yourself. You will have some handy little procedures and knowledge few possess. The caveat is that some docs may still not think you are a real doc, if you care about such things. You can "cure" acne and early melanoma

Optho - Don't know enough about it, but its a possibility for me. Is it too specialized though? Again, forget about what others think. Optho is a fascinating field with a lot of variety, from trauma to glaucoma, and you can "cure" cataracts and restore vision! Definitely do an elective in this field

ENT - A 5 year residency and you are a surgical specialist! Manage everything from chronic sinusitis to hearing loss. Insert cochlear implants and 'cure" deafness, fix a deviated nasal septum and the chronically SOB pt can become a runner! Lots of prestige and moula, like the previous specialties you mentioned.

Psychiatry seems wonderful as well, if you are willing to take the pay cut.

Check out the UVa Medical specialties and Careers in Medicine sites as well. It would be easy-peasy to take electives in a few of these fields.
My $0.02

 

[drfunktacular]

I'm pretty sure trauma surgery is what everyone should want to go into. I've really zeroed in on this in the past few weeks.

Of course, I don't start med school until July, so I could change my mind, but its going to be hard to change my mind from this.

I volunteer at a trauma center right now, and I get fired up when I hear them page a trauma stat. And I don't even do anything. I can only imagine how cool it will be to actually get in there and go to work.

WOW, you have never done an actual trauma surg rotation.

 

[smq123]

I'm pretty sure trauma surgery is what everyone should want to go into. I've really zeroed in on this in the past few weeks.

Of course, I don't start med school until July, so I could change my mind, but its going to be hard to change my mind from this.

I volunteer at a trauma center right now, and I get fired up when I hear them page a trauma stat. And I don't even do anything. I can only imagine how cool it will be to actually get in there and go to work.

It's probably cooler in your imagination than it is to "actually get in there and go to work."

A lot of trauma call involves lap appes at 2 AM. Or stat I&D or hematoma evacuation at 4 AM. Or working up the old guy who stumbled off of his porch and banged his head. Or emergency PEG placement. Unless you work in the ghetto, you won't see that many GSWs.

Ortho, neurosurg, and ENT handle a lot of trauma as well, particularly at big medical centers. They probably get fewer, but more exciting, trauma cases than your average trauma surgeon. OB/gyn handles some acute cases. And, of course, EM sees it all. So don't discount these fields if you like acute care.

 

[drfunktacular]

It's probably cooler in your imagination than it is to "actually get in there and go to work."

A lot of trauma call involves lap appes at 2 AM. Or stat I&D or hematoma evacuation at 4 AM. Or working up the old guy who stumbled off of his porch and banged his head. Or emergency PEG placement. Unless you work in the ghetto, you won't see that many GSWs.

Ortho, neurosurg, and ENT handle a lot of trauma as well, particularly at big medical centers. They probably get fewer, but more exciting, trauma cases than your average trauma surgeon. OB/gyn handles some acute cases. And, of course, EM sees it all. So don't discount these fields if you like acute care.

This is true. Trauma more than anything else is sleepwalking your way through appy's or an I&D on some junkie's infected tract marks. Unless you are in the straight-up ghetto you will do probably 10 of these for every 1 GSW exploration.

If you really are into "trauma" as you probably imagine it, orthopods are the ones who do most of the real work on trauma patients (ORIFs, pin placements, washouts, etc). Then they turn them back over to the trauma service, who manages them in the ICU and on the floor for 3 weeks; in this respect it is almost indistinguishable from an IM service.

 

[Arctic Char]

If you went into medicine with the intention of "curing" people, you're going to be dissapointed no matter what field you go into. The patients have complex diseases, which doctors may be able to treat but not necessarily fix. I can't think of any rotation that I've been on where even 20% of the patients came out healed as a result of the doctor's intervention. Most patients left a little better than when they came in. Some even left worse.

A doctor is hired to provide a service, either giving advice about a medical problem or performing some kind of procedure. If you define your success as the patient being cured by your intervention, then you are setting yourself up for a career of dissapointment. The same goes even if you consider success being whether or not the patient decides to heed your advice.

Either way, I think the ability to effect "cures" should be the last thing you look at when considering a specialty.

while i don't entirely disagree with you, you must admit that there are comparatively huge differences between fields of medicine and the "curability" of their common patients. internal medicine . . . you're either going to die in the ward, or you are leaving with a chronic condition or ailment . . . with, of course, a few total resolutions interspersed here and there. hard24get mentioned some of the ways you'd see success in internal, but its still pretty dreary overall if you ask me. but take derm for instance: someone walks into your office with cancer, they can walk out without it. same goes for pain management. although chronic pain is not necessarily "cured", again, someone can walk into your office with pain and then walk out without it in 15 minutes. that sounds like it could be very rewarding work. and even look at peds: yes, a lot of the little dudes have very serious conditions, but you see far more "serious" conditions that can still - with adequate treatment - afford the child another 20, 30, 40+ years of life. that may not constitute a "cure" per se, but its a more inspiring outcome than: i'm sorry sir, you have acute on chronic renal failure, you need better control of your diabetes-betes-betes, and, congratulations, you are johnson and johnson's 100-millionth customer!!

 

[PeepshowJohnny]

although chronic pain is not necessarily "cured", again, someone can walk into your office with pain and then walk out without it in 15 minutes. that sounds like it could be very rewarding work.

Man, where are you finding your chronic pain patients?

Mine are like this:

Walk into room with fifty year old obese woman who looks at my uninterested. Introduce myself, patient still looks uninterested/slightly annoyed. Ask about how their back pain/fibromyalgia/headaches whatever is doing, they state the non narcotic medications we've given them isn't helping, they ask for more narcs/benzos. Attempt to explain to patient how long term narcotic use can lead to more pain and a boatload of problem, get their refill/upgrade. Lather rinse repeat every three months.

The only people I've ever seen make a difference in chronic pain are those Pain Medicine doctors and only because they're awesome at slowly weaning people off the narcotics and getting them to address the psychological and social issues that are causing them problems.

 

[AmoryBlaine]

I'm pretty sure trauma surgery is what everyone should want to go into. I've really zeroed in on this in the past few weeks.

Of course, I don't start med school until July, so I could change my mind, but its going to be hard to change my mind from this.

I volunteer at a trauma center right now, and I get fired up when I hear them page a trauma stat. And I don't even do anything. I can only imagine how cool it will be to actually get in there and go to work.

A very common reaction to trauma pages from pre-meds and younger med students. Compared to ambulatory primary care trauma is exciting, but a few thoughts.

1. A properly run trauma is an algorithm, as such it is not very often a deeply cerebral exercise.

2. Trauma patients suck. For every 16 year old hit by a drunk driver you get 15 drunk drivers. For every kid caught by a stray bullet you get 10 gang-members. These people are often intoxicated and combative -- very exciting for a first year med student who is shadowing but I have seen nurses/docs/techs come very close to serious injury while trying to manage a trauma patient.

3. As others have said, becoming a Trauma surgeon is largely becoming a surgical intensivist. Many people labor under the mistaken impression that patients often go straight from the ER to the OR. After doing almost a month total of trauma I have seen this happen once (not counting Ortho procedures) and in a different center this guy would have gone with ENT, not Tsurg. The care of the traumatically injured occurs in the SICU and on the floor.

But, like I said before, it is more exciting than managing HgbA1cs...

 

[TexasTriathlete]

Hey, I'll be the first to admit that I don't know enough to make a decision about this yet. However, I do know that there are some things I won't want to do.

I am diagnosed with ADHD, and I think its something about how stress and pressure helps me to focus. I think I would be at my best in situations like traumas. And yeah, I know that it isn't all GSW's, but I would have no problem working in the ghetto either.

And I'm not worried about mixing it up with combative patients. I do that already as a volunteer. I'm 6'4.5" and 225#, and I'm not about to let someone hurt my techs, docs, and nurses. My volunteer shift, by choice, is 11pm-3am on friday and saturday.


Also, my impression of trauma surgery is not from some TV fantasy land, or my imagination. I know the trauma surgeons at the hospital pretty well, and one of them has even been a client of mine. I've talked with them about it in-depth.

Of course, I reserve the right to change my mind. I'm sure there will be other things out there that I like too.

 

[drfunktacular]

Also, my impression of trauma surgery is not from some TV fantasy land, or my imagination. I know the trauma surgeons at the hospital pretty well, and one of them has even been a client of mine. I've talked with them about it in-depth.

Well, I would say think of it this way: if you are volunteering in the ER/Trauma center, you are seeing maybe 20% of what trauma docs actually do all day. For every hour they spend coding some gnarly multi-trauma victim or fishing fragments out of a GSW, they spend probably 10-15 on scut-type ICU stuff, i.e., ROUNDING (TONS of this), managing vent settings, assessing antibiotic coverage, coordinating PT/OT/RT and other rehab care, securing rehab hospital placement (if insurance will cover it (if they have insurance - ha!)), consulting and getting back consult reports from cardio, ortho, IM, etc. If these things excite your pants off, more power. But it's not what I imagined trauma docs to do all day when I was getting all pumped up for my trauma rotation.

 

[TexasTriathlete]

But isn't that true of nearly every area of medicine? If I'm wrong, please point me to the specialty that is all fun and games, and I'll start taking the necessary steps to match into it.

 

[drfunktacular]

But isn't that true of nearly every area of medicine? If I'm wrong, please point me to the specialty that is all fun and games, and I'll start taking the necessary steps to match into it.

This is completely true. It's just that I found this to be a field in which the "general public" view is especially out of sync with the reality. And based on my experience, it's trending ever more rapidly toward the "surgical intensivist" role as more and more non-ortho trauma conditions are deemed non-operative/observation.

 

[climbingdocs]

I am gonna love Anesthesia I am going to wear pajamas to work, no need to worry about hair, will have to do only half makaup cause the other part of face will be covered, I will get to read newspapers as I sit on my butt. Then I get to go home, turn off the pager and enjoy my life. And who says anesthesiologist is not a real doc? I can give you a reason why any other speciality is not real medicine. It's all they way you look at it.

 

[funkless]

I'm pretty sure trauma surgery is what everyone should want to go into. I've really zeroed in on this in the past few weeks.

Of course, I don't start med school until July, so I could change my mind, but its going to be hard to change my mind from this.

I volunteer at a trauma center right now, and I get fired up when I hear them page a trauma stat. And I don't even do anything. I can only imagine how cool it will be to actually get in there and go to work.

And I'm not worried about mixing it up with combative patients. I do that already as a volunteer. I'm 6'4.5" and 225#, and I'm not about to let someone hurt my techs, docs, and nurses.

Keep "mixing it up" and enjoy a lifetime of lawsuits and hepatitis.

 

[funkless]

But isn't that true of nearly every area of medicine? If I'm wrong, please point me to the specialty that is all fun and games, and I'll start taking the necessary steps to match into it.

Here's two: radiology and pathology.

 

[Green Chimneys]

Keep "mixing it up" and enjoy a lifetime of lawsuits and hepatitis.

Thread winner right there.

And I think the OP is a surgeon at heart and just afraid to make the leap. Just close your eyes, have faith, and check that box on the NRMP. Good luck!

 

[smq123]

I am diagnosed with ADHD, and I think its something about how stress and pressure helps me to focus. I think I would be at my best in situations like traumas. And yeah, I know that it isn't all GSW's, but I would have no problem working in the ghetto either.

There are other specialties that involve stress and pressure. ENT, like I mentioned. Neurosurgery - probably sees more "true traumas" than trauma surgery does. OB/gyn, particularly OB. Emergency medicine (obviously).

They should stop calling it "trauma" surgery. I think the name is highly misleading since over 80% of their patients were not involved in anything remotely traumatic.

Well, I would say think of it this way: if you are volunteering in the ER/Trauma center, you are seeing maybe 20% of what trauma docs actually do all day. For every hour they spend coding some gnarly multi-trauma victim or fishing fragments out of a GSW, they spend probably 10-15 on scut-type ICU stuff, i.e., ROUNDING (TONS of this), managing vent settings, assessing antibiotic coverage, coordinating PT/OT/RT and other rehab care, securing rehab hospital placement (if insurance will cover it (if they have insurance - ha!)), consulting and getting back consult reports from cardio, ortho, IM, etc. If these things excite your pants off, more power. But it's not what I imagined trauma docs to do all day when I was getting all pumped up for my trauma rotation.

Don't forget all the social work that trauma surgeons get to do!

I think that they're kind of like the family practitioners of surgery. They do a little bit of everything, are overworked, underpaid (for what they do), and do a lot of social work/patient placement stuff. Not to mention that their patient lists are easily 4 times longer than any other service.

But isn't that true of nearly every area of medicine? If I'm wrong, please point me to the specialty that is all fun and games, and I'll start taking the necessary steps to match into it.

No one is saying "Oh, you don't know how hard trauma surgery is." Everyone is saying "Oh, you don't know how monotonous trauma surgery is." It's a good field and definitely serves an important role. But it's not what everyone thinks it is.

 

[drfunktacular]

Don't forget all the social work that trauma surgeons get to do!

I think that they're kind of like the family practitioners of surgery. They do a little bit of everything, are overworked, underpaid (for what they do), and do a lot of social work/patient placement stuff. Not to mention that their patient lists are easily 4 times longer than any other service.

I have never thought of it this way, but this is hilariously true. You REALLY see this in trauma clinic. And true dat about the trauma census; my god is rounding hellish on a trauma service.

 

[getunconcsious]

I think yall should let up on TexasTriathelete. He sounds like he does have *some* idea of what a trauma service does. I don't doubt that trauma surg truly sucks a$$ (it's about the LAST thing I'd ever want to do) but all specialties suck to some extent. You have to pick your poison so to speak. If he thinks he can tolerate long rounds, lotsa heroin junkies, and I&D's out the ass then more power to him. Everyone has to tolerate something that sucks. Even in Path which funklessjonny pointed out as "all fun and games" has things like reading 1000's of pap smears, autopsies on the morbidly obese, and specimen grossing marathons. I'm more willing to tolerate that stuff though than any of the other BS in the other specialties.

TexasTri, I think it's good that you have an early interest in a specialty. You will almost certainly change your mind at some point (perhaps permanently, perhaps not, but everyone does it) but I think having some end-goal to strive for, no matter how nebulous or perhaps ultimately ill-conceived, is better than having no goal at all. I had no idea what I was interested in MS1 and everything seemed to suck, so I did badly. Without an end-game of any kind, my motivation to even try was gone. Of course, then I took Histo and fell in love with path.

 

[smq123]

I think yall should let up on TexasTriathelete. He sounds like he does have *some* idea of what a trauma service does. I don't doubt that trauma surg truly sucks a$$ (it's about the LAST thing I'd ever want to do) but all specialties suck to some extent. You have to pick your poison so to speak.

No one is calling him stupid or saying "Trauma surg sucks, don't do it." Actually, as the surgery specialties go, it's not terrible. You get a lot of basic, bread-and-butter surgeries in, and the cases are not all that long. It's not like pancreatic surgeons (Whipples are generally > 5 hours long) or like transplant surgeons.

It's not terrible, but it's not as exciting as everyone thinks it is. As AmoryBlaine and drfunktacular have pointed out, it's rare to go straight from ER to OR. And if you do, it's more likely because of a bowel perf, a bowel obstruction, or appendicitis. And then you get to add that patient to your census, which in most hospitals is ~ 3 pages long.

If he thinks he can tolerate long rounds, lotsa heroin junkies, and I&D's out the ass then more power to him.

That's just what we've been saying - it doesn't seem like TexasTriathlete realized that those things form the majority of the trauma service's responsibilities.

It's like someone telling you "I want to do OB/gyn because I want to take care of women who are pregnant. All the pregnant women that I've ever met are happy, glowing, and excited to give birth!" Um...well....

[Yes, I want to do OB/gyn - but it's in spite of the "few" pregnant women who weren't happy, glowing, and excited to give birth. ]

 

[funkless]

It's like someone telling you "I want to do OB/gyn because I want to take care of women who are pregnant. All the pregnant women that I've ever met are happy, glowing, and excited to give birth!"

Yeah, and if the babydaddy gets disruptive, I can pummel him into submission with impunity! It's not like people carry guns into hospitals or anything! And it's not like your garden-variety ER denizen harbors any communicable diseases! And there's no way they'd involve the courts--most of my patients will stand to lose as much as I, the physician!


Sorry, I don't mean to be a total douchebag, but that guy was begging for some mild-to-moderate mocking.

 

[TexasTriathlete]

I am a 30-year-old non-trad. Not some 22-year-old gunner who has seen ER one too many times. A friend of mine is a trauma surgeon where I volunteer. I've talked to him in great depth about what he does, and I see a lot of what goes from the ER to the OR in my volunteering. And my trauma center is hardly in the ghetto.

I really do have a better grasp on this than you think. My initial statement about trauma surgery was hyperbole. At the same time, it seems like the kind of thing I'd enjoy more than other areas of medicine. The possibility for something different every time is intriguing to me. I think I would enjoy dabbling in different types of procedures.

 

[Pinkertinkle]

A little early for premeds to be in the clinical rotations forum eh?

 

[latinfridley]

I am a 30-year-old non-trad. Not some 22-year-old gunner who has seen ER one too many times. A friend of mine is a trauma surgeon where I volunteer. I've talked to him in great depth about what he does, and I see a lot of what goes from the ER to the OR in my volunteering. And my trauma center is hardly in the ghetto.

I really do have a better grasp on this than you think. My initial statement about trauma surgery was hyperbole. At the same time, it seems like the kind of thing I'd enjoy more than other areas of medicine. The possibility for something different every time is intriguing to me. I think I would enjoy dabbling in different types of procedures.

Its good to see enthusiasm early on. Remember to keep an open mind as there are many fantastic fields of medicine, and if you still like trauma surg, go for it. We need more of em in many parts of the country.

 

[smq123]

I am a 30-year-old non-trad. Not some 22-year-old gunner who has seen ER one too many times. A friend of mine is a trauma surgeon where I volunteer. I've talked to him in great depth about what he does, and I see a lot of what goes from the ER to the OR in my volunteering. And my trauma center is hardly in the ghetto.

I really do have a better grasp on this than you think. My initial statement about trauma surgery was hyperbole. At the same time, it seems like the kind of thing I'd enjoy more than other areas of medicine. The possibility for something different every time is intriguing to me. I think I would enjoy dabbling in different types of procedures.

FYI - If you hang out with a lot of surgeons, any statement that borders on "hyperbole" in front of a surgeon is like throwing a fresh salmon in front of a grizzly bear. Just something to keep in mind for the future. (Yes, I learned this the hard way. )

Great, you have a friend in trauma surgery. Ask him if you can hang out with him ALL DAY LONG, for 2-3 days straight. (If your work schedule allows this.) I mean, from the moment he starts pre-rounding to the moment he goes home. It'll let you know how much fun running the trauma list can be.

You may have a good grasp on trauma (we'll see, based on how you react to that 2-3 day experiment that I mentioned above), but you don't have a good grasp on other fields in medicine, so you have very little to compare it to. What you've described also describes ENT very well - large variety of procedures (from tonsillectomies to fibular free flaps) and deals with emergencies (airway emergencies, difficult intubations, or even tracheotomies on people who are still AWAKE ). [One ENT attending says that half of his gray hairs are from his kids, but the other half are from all the awake trachs he's had to do.] It also describes OB/gyn. It also describes Emergency Med.

I think it's important to realize which characteristics you're looking for in a field - which you've already done. But trauma surgery isn't the only thing that fulfills those criteria.

 

[funkless]

Great, you have a friend in trauma surgery. Ask him if you can hang out with him ALL DAY LONG, for 2-3 days straight. (If your work schedule allows this.) I mean, from the moment he starts pre-rounding to the moment he goes home. It'll let you know how much fun running the trauma list can be.

And even that will pale in comparison to what the experience is like when you're actually expected to know everything. In your current role, you're essentially a tourist. Acute medicine/surgery is definitely a situation where observing and participating are worlds apart. So while what you're doing is great exposure to the field, never forget the words of Tyler Durden-- "sticking feathers up your butt does not make you a chicken."

 

[Llenroc]

Hey, I'll be the first to admit that I don't know enough to make a decision about this yet. However, I do know that there are some things I won't want to do.

I am diagnosed with ADHD, and I think its something about how stress and pressure helps me to focus. I think I would be at my best in situations like traumas. And yeah, I know that it isn't all GSW's, but I would have no problem working in the ghetto either.

And I'm not worried about mixing it up with combative patients. I do that already as a volunteer. I'm 6'4.5" and 225#, and I'm not about to let someone hurt my techs, docs, and nurses. My volunteer shift, by choice, is 11pm-3am on friday and saturday.


Also, my impression of trauma surgery is not from some TV fantasy land, or my imagination. I know the trauma surgeons at the hospital pretty well, and one of them has even been a client of mine. I've talked with them about it in-depth.

Of course, I reserve the right to change my mind. I'm sure there will be other things out there that I like too.

Nobody is impressed with your height. Why don't you try coming into work at 5:30 everyday for a month, before opening your trap and acting like you actually know something, which you obviously don't.

 

[TexasTriathlete]

I am at work at 5:30 most days. Sometimes I'll run before that. Sometimes I'll get my workouts in throughout the day. I typically operate on about 4-5 hours of sleep easily. I could go on less if I had to, or if I wasn't training as much.

And I mentioned my size to prove a point: that I can hold my own against combative patients. I really don't care if anyone is impressed.

Why do I make you so upset?

 

[drfunktacular]

I am at work at 5:30 most days. Sometimes I'll run before that. Sometimes I'll get my workouts in throughout the day. I typically operate on about 4-5 hours of sleep easily. I could go on less if I had to, or if I wasn't training as much.

And I mentioned my size to prove a point: that I can hold my own against combative patients. I really don't care if anyone is impressed.

Why do I make you so upset?

Sorry to have opened this can of worms

I was mainly just venting about what a steaming pile my trauma rotation turned out to be. I hope we haven't discouraged you in your interests--it's better to have an area that excites you than to be cynical going in!

If trauma is really for you, you'll know it; until then just keep an open mind, and don't let us jaded ones change your mind (although if you're crazy enough to run triathlons, I'm sure you're not the type to listen to reason anyway ).

 

[TexasTriathlete]

As a triathlete, I define my happiness by how much pain I can endure.