Choosing a specialty: What do you want to be when you grow up?

[orthogenes]

If you did not know what kind of medicine you wanted to practice before med school--how did you decide?
I'm halfway through third year and still trying to figure it out.

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[Winged Scapula]

Junior High: neurosurgery

HS: psychiatry

College/Pre Med: Neurology or Endocrinology

Med School first 2 yrs: Family Med or Endo

Med School clinical years: FM oh god no; IM meh; Psych bleh; Ob gyn: pretty good; Surgery: ok now this is cool

Lots of people have difficulty choosing a specialty and we do have artificially push people into making a decision early on here in the states.


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[DrLefty]

Junior High: neurosurgery

HS: psychiatry

College/Pre Med: Neurology or Endocrinology

Med School first 2 yrs: Family Med or Endo

Med School clinical years: FM oh god no; IM meh; Psych bleh; Ob gyn: pretty good; Surgery: ok now this is cool

Lots of people have difficulty choosing a specialty and we do have artificially push people into making a decision early on here in the states.


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What was it about FM in the clinic that made you not want to do it?




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[Winged Scapula]

I was incredibly bored in FM, didn't like the constant near sameness of each day, the feeling that we werent fixing anything and probably most of all, the attending's annoying penchant for talking about how he, the lowly FM, was able to diagnose something that none of the specialists could figure out. You know, because he was the smartest and best doctor evah. Tainted the whole specialty for me.

 

[doctorbunny]

Funny how similar our attendings have been. My experience in FM was a lot the same, except my attending also lectured us on how to get rich in FM, which was possibly even worse than hearing about his ability to heal the unknown. He also enjoyed talking about the golden age of medicine when pharm reps could shower him with gifts and trips.
When we had any questions, he generally could not answer but would diplomatically put us off, (unless it had to do with one of the 30 medications for chronic adult diseases that he gave out on a day to day basis).
I do think I would have liked it more if I had liked my attending. For example, Pediatrics is 'general medicine' but the doc I shadowed was truly a 'lifelong learner' who was interesting, more willing to teach, and more humble. I didn't feel bored there at all.
It seems like the rotations where I click with attendings and residents and find a mentor I can see myself emulating is where I am drawn.
Is this anyone else's experience? Can whoever you are assigned to learn from change your heart on a speciality you were previously against, or visa versa?


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[SierraMist14]

If you did not know what kind of medicine you wanted to practice before med school--how did you decide?
I'm halfway through third year and still trying to figure it out.

I've always wanted to be a surgeon growing up. In first and second year, I wanted to be a trauma surgeon.

Third year, I switched to OB/GYN.

At the very end of third year, I decided on Anesthesia, which is what I'll be starting in 6 months.

It all comes down to being honest with yourself. What do you dislike? What can you honestly see yourself doing in the future, and will you be happy doing it? No specialty is perfect; pick what you can tolerate the most and go with that.

 

[BigRedBeta]

A couple points I used to tell students when I was in training and dealing with them more often.

Think big buckets so you can start ruling things out large numbers of things quickly. The biggest decision is whether you need the OR or not. If you're only looking at surgical specialties and anesthesia, the options start to separate themselves pretty readily. If you're in medical fields, then your next decision is children vs adults. From there, usually the next step is to decide if you want to be more general vs an expert in one specific organ. For example in peds, that separates out critical care, EM, gen peds, and neonatology from pulm/cards/GI/endo/neuro/etc.

The other key point is to remember that common things are common in all fields of medicine. So while you might see some really amazing surgical procedure because you're at an academic medical center, that's not likely to be typical day to day when you're out in practice. So you have to find a specialty where you dont' mind treating the top 5 most common problems at 2 am in the morning. You don't have to LOVE all top 5 issues, but they shouldn't be intolerable.

 

[jqueb29]

I've wanted to do anesthesia since like junior year of high school and still have that as my #1 as an MS3. Honestly though I have literally no recollection of how exactly I originally came up with anesthesia, but I'm glad I did. It's an extremely good lifestyle field.

 

[yanks26dmb]

I've wanted to do anesthesia since like junior year of high school and still have that as my #1 as an MS3. Honestly though I have literally no recollection of how exactly I originally came up with anesthesia, but I'm glad I did. It's an extremely good lifestyle field.

In talking to a family member just out out residency, I got really turned on to anesthesia. I'm an M2, so you probably know a great deal more than I do. Is there anything else you can fill me in about the lifestyle aspects, job market, etc? Would appreciate anything you've got!

 

[jqueb29]

In talking to a family member just out out residency, I got really turned on to anesthesia. I'm an M2, so you probably know a great deal more than I do. Is there anything else you can fill me in about the lifestyle aspects, job market, etc? Would appreciate anything you've got!

I'll respond with a more full answer after my IM shelf Friday, but for now, the main thing that I like as far as lifestyle is the sheer variety of options. It's easy to find jobs where you work really hard and make more money, but it's also easy to find jobs with fewer hours that still pay well. A few other things I like:

1. A lot less non-medical nonsense than other fields. Anesthesiologists don't have to waste time writing their daily note for 15 patients a day. They pre-op patients before surgery, run the case, get the patient through the recovery room, and then that's it. No coming around for the next 2 weeks to follow up and manage chest tubes or medication changes. You get a patient through surgery and recovery and you're done with them.

2. On a similar note, when you're done working, you're done. You're not like a surgeon, who may be at home and not even on call at the time but suddenly something bad happens with one of your patients and you need to come in. You're not an Ob-gyn, who has to worry at any given moment that one of your patients might go into labor and you need to come deliver their baby, so you're essentially on call all the time. You're not an internist, who has a list with tons of patients and comes in every day having to manage all kinds of new developments. An anesthesiologist pre-ops a patient, gets them through the procedure and out of the PACU, and that's it. It's one of the very few fields where, when you're off duty, you are actually 100% off duty.

 

[orthogenes]

The other key point is to remember that common things are common in all fields of medicine. So while you might see some really amazing surgical procedure because you're at an academic medical center, that's not likely to be typical day to day when you're out in practice. So you have to find a specialty where you dont' mind treating the top 5 most common problems at 2 am in the morning. You don't have to LOVE all top 5 issues, but they shouldn't be intolerable.

This is fantastic advice. Thank you.

 

[yanks26dmb]

I'll respond with a more full answer after my IM shelf Friday, but for now, the main thing that I like as far as lifestyle is the sheer variety of options. It's easy to find jobs where you work really hard and make more money, but it's also easy to find jobs with fewer hours that still pay well. A few other things I like:

1. A lot less non-medical nonsense than other fields. Anesthesiologists don't have to waste time writing their daily note for 15 patients a day. They pre-op patients before surgery, run the case, get the patient through the recovery room, and then that's it. No coming around for the next 2 weeks to follow up and manage chest tubes or medication changes. You get a patient through surgery and recovery and you're done with them.

2. On a similar note, when you're done working, you're done. You're not like a surgeon, who may be at home and not even on call at the time but suddenly something bad happens with one of your patients and you need to come in. You're not an Ob-gyn, who has to worry at any given moment that one of your patients might go into labor and you need to come deliver their baby, so you're essentially on call all the time. You're not an internist, who has a list with tons of patients and comes in every day having to manage all kinds of new developments. An anesthesiologist pre-ops a patient, gets them through the procedure and out of the PACU, and that's it. It's one of the very few fields where, when you're off duty, you are actually 100% off duty.

Thanks for the opinion...looking forward to whatever else you can tell me about the field. good luck on the shelf.

 

[ortnakas]

A couple points I used to tell students when I was in training and dealing with them more often.

Think big buckets so you can start ruling things out large numbers of things quickly. The biggest decision is whether you need the OR or not. If you're only looking at surgical specialties and anesthesia, the options start to separate themselves pretty readily. If you're in medical fields, then your next decision is children vs adults. From there, usually the next step is to decide if you want to be more general vs an expert in one specific organ. For example in peds, that separates out critical care, EM, gen peds, and neonatology from pulm/cards/GI/endo/neuro/etc.

The other key point is to remember that common things are common in all fields of medicine. So while you might see some really amazing surgical procedure because you're at an academic medical center, that's not likely to be typical day to day when you're out in practice. So you have to find a specialty where you dont' mind treating the top 5 most common problems at 2 am in the morning. You don't have to LOVE all top 5 issues, but they shouldn't be intolerable.

I'm just a lowly 3rd year, but this echoes the advice I've been given by a couple of mentors. Thank you!

Adding to your second point, one person told me to pick the field with your favorite bread and butter even if it doesn't have your favorite zebras.

 

[Thalamood]

If you did not know what kind of medicine you wanted to practice before med school--how did you decide?
I'm halfway through third year and still trying to figure it out.

I've always found this to be helpful


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[NWwildcat2013]

View attachment 212993

I've always found this to be helpful


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This brings me to ophtho or derm, but the problem is you can't just waltz into those at the last minute even with amazing grades. Basically the entire branch after "My class hates me" needs to loop back to other options depending on how much time you have left in med school and whether you are willing to take a gap year for research.

 

[SKaminski]

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[SKaminski]

So, my issue is that I like nearly everything i've done, but absolutely despise outpatient family medicine and pediatrics.

Psychiatry? So reaffirming. Having people open up to you and share things with that they don't even share with their spouses is... very significant.

Surgery? One of the coolest things i've ever seen. Open abdominal surgeries were interesting and invigorating... for the one month I did them. Ending the day gave me a feeling of meaningfulness. Taking care and of solving acute issues made me feel like we had actually accomplished something. This honestly blew me away, but i'm worried about the lifestyle, and the fact that the bread-and-butter is boring to me. (Hernia repairs, ect).

Internal Medicine? I liked seeing patients several times a day, and making changes in their care. I didn't like a census of 20, though.

Critical Care? Only got to see this for a few days. A census of 10 allows you to spend more time with patients. Counseling families allows psych. Minor procedures to take the place of surgery. Shift work for a life. It seems like the best choice, but i'm so scared i'm choosing wrong, that i'll be forever disappointed if i dont do surgery, and:

What path do I take to get into critical care? Internal Medicine? Emergency Medicine? Anesthesiology? General Surgery?
From there, MICU or SICU?

... Anyways. These are the thoughts that have been running around in my head. Whats very important to me is being able to do procedures, to work with my hands, and to connect with people. And a decent lifestyle (hopefully shift work). I'm not a martyr.

Maybe internal medicine because it keeps my options open to also go into cardiology or GI.