Choosing a specialty

[TorMed]

I am getting toward the end of second year. I have been interested in a wide variety of the topics we have covered and I have a number of areas that I would be interested in doing extra electives in but I don't want to look like I'm all over the place when I finally pick a specialty.

The three areas I am interested in are anesthesiology, an internal medicine specialty or maybe psych. Sounds bizarre? The practices would be wildly different.

I tried the specialty selector but it gave me a bunch of suggestions I really didn't like.


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[Cytarabine]

I am getting toward the end of second year. I have been interested in a wide variety of the topics we have covered and I have a number of areas that I would be interested in doing extra electives in but I don't want to look like I'm all over the place when I finally pick a specialty.

The three areas I am interested in are anesthesiology, an internal medicine specialty or maybe psych. Sounds bizarre? The practices would be wildly different.

I tried the specialty selector but it gave me a bunch of suggestions I really didn't like.


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Why do you like those fields and dislike the ones the specialty selector gave you? You're not really giving any information other than you think you like disparate specialties

 

[ProfMD]

Most people start with simple binary questions:
Surgical vs nonsurgical
Direct patient care vs not
Kids vs adults

You can then start thinking about what organ systems and disease processes interest you.

Another piece of advice I got was to find the most routine aspect of each speciality, such as what are the most boring straight forward common conditions each specialty treats. Make sure you can see yourself taking care of those patients / responsibilities.

You also need to consider what it is about each of those specialities that you find interesting.

The most crucial part of choosing a speciality is to be honest with yourself. Forget what other people think you should do - it's your life.

Finally, keep an open mind. You may find during third year that you don't like any of those specialities you listed and fall in love with somethings else entirely.

 

[OnePunchBiopsy]

You should get a good idea of preferred specialty during 3rd year. I wanted to be an oncologist after 2nd year because all the material about cancer sounded great in a textbook. Turns out the practice of oncology (and IMED in general) was not my cup of tea.

Now I am 100% pursuing general surgery. Your choice may surprise you; mine did.

EDIT: Also, those specialty surveys may give biased results if you complete them with a preferred specialty in mind. Nephrology was my top match in 2nd year, now my #1 is ortho (gen surg is #3)

 

[akwho]

Break it down: Decide surgeon vs proceduralist vs thinker.

1. Surgeons
   • Brutal hours: Gen Surg, Neurosurg, Ortho
   • Life after residency: ENT, Uro, Plastics
2. Proceduralists
   • Like clinic: GI, Pulm, Interverntional cards, Opthalmology, Derm
   • Hate clinic: EM, IR, Anesthesia
   • Hate everyone and everything: Ob/gyn
3. Thinkers
   • Like kids: Peds
   • Hate kids: Medicine
   • Like everyone: FM
   • Hate everyone: Path
   • Hate work/Love life: PM&R, Psych

If you find yourself in one of these subcategories with multiple fields in play, stratify by:

1) Intellectual interest in that speciality
2) Ability to get into the speciality
3) "Finding your people" (ie you fit in with the people in that speciality)
4) Pay/lifestyle combo of that speciality
​

 

[Gambler 101]

I was struggling toward the end of third year. It helped me to think about what I'd want to be doing if 1) it was my last possible day as a physician or 2) I was having a really crappy day and had to go to work.


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[NickNaylor]

I agree with the approach of first deciding surgery vs. not surgery. It's a basic point but has significant ramifications with respect to lifestyle, the "type" of medicine practice, etc..

Beyond that, work hard in your rotations, try and emulate the work, and think about what you enjoy doing. Pay special attention to lifestyle, the available possibilities with respect to the type of work you can do (e.g., inpatient vs. outpatient vs. mix of both vs. others), and whether you want to have a family, be involved in other things outside of medicine, etc.. You are still early on in your training. It's not unreasonable to have ideas about what you want to do but still not be sure. I didn't become completely sure of what I wanted to do until the end of third year. Think about fields that are competitive vs. not competitive and what that means to you for the next several years (i.e., being able to "choose" where you train). This is especially important if you have family in tow with you. Think about whether you can imagine yourself doing [x] work for 20 years, day in and day out, at least 40 hours a week but in all likelihood more than that. That can be a difficult thing to ascertain but is worth considering.

As I said, go through your rotations with eyes wide open and pay attention to what's going on. Some people still finish third year with a couple of options. That's ok. Eventually you'll figure it out. At this point, unless you're sure you want to go into something super competitive, I wouldn't get too worried about this. You're about par for the course I'd say in terms of your progress in choosing what you want to do when you grow up.

 

[smokn]

Break it down: Decide surgeon vs proceduralist vs thinker.

1. Surgeons
   • Brutal hours: Gen Surg, Neurosurg, Ortho
   • Life after residency: ENT, Uro, Plastics
2. Proceduralists
   • Like clinic: GI, Pulm, Interverntional cards, Opthalmology, Derm
   • Hate clinic: EM, IR, Anesthesia
   • Hate everyone and everything: Ob/gyn
3. Thinkers
   • Like kids: Peds
   • Hate kids: Medicine
   • Like everyone: FM
   • Hate everyone: Path
   • Hate work/Love life: PM&R, Psych

If you find yourself in one of these subcategories with multiple fields in play, stratify by:

1) Intellectual interest in that speciality
2) Ability to get into the speciality
3) "Finding your people" (ie you fit in with the people in that speciality)
4) Pay/lifestyle combo of that speciality
​

This post should be the first reply to all of the weekly "Choosing a Specialty" threads.

 

[Petypet]

http://www.nickdr.com/#!Goals-for-year-3-of-medical-school/c21kp/570fbb9f0cf21d11795a3f26

 

[TorMed]

Thanks for everyone's input. I'm pretty sure I don't want to do surgery. I think the first big thing to do is decide whether I want to do procedures. I need to get hands on and see if I like doing them and am good at them.



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[TheFutureFatMan]

Break it down: Decide surgeon vs proceduralist vs thinker.

1. Surgeons
   • Brutal hours: Gen Surg, Neurosurg, Ortho
   • Life after residency: ENT, Uro, Plastics
2. Proceduralists
   • Like clinic: GI, Pulm, Interverntional cards, Opthalmology, Derm
   • Hate clinic: EM, IR, Anesthesia
   • Hate everyone and everything: Ob/gyn
3. Thinkers
   • Like kids: Peds
   • Hate kids: Medicine
   • Like everyone: FM
   • Hate everyone: Path
   • Hate work/Love life: PM&R, Psych

If you find yourself in one of these subcategories with multiple fields in play, stratify by:

1) Intellectual interest in that speciality
2) Ability to get into the speciality
3) "Finding your people" (ie you fit in with the people in that speciality)
4) Pay/lifestyle combo of that speciality
​

Why do you say that about obgyn? I've worked in the field for years and was considering looking at that as a specialty (though I know absolutely nothing from the perspective as a medical student). I'd appreciate some elaboration, if you have the time. Thanks!


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[TheFutureFatMan]

Why do you say that about obgyn? I've worked in the field for years and was considering looking at that as a specialty (though I know absolutely nothing from the perspective as a medical student). I'd appreciate some elaboration, if you have the time. Thanks!


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Also I don't understand what you mean by "proceduralists." Sorry to be a bother.


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[akwho]

Why do you say that about obgyn? I've worked in the field for years and was considering looking at that as a specialty (though I know absolutely nothing from the perspective as a medical student). I'd appreciate some elaboration, if you have the time. Thanks!

Just poking the bear -- I actually enjoyed my Ob/gyn rotation, but as you can see on threads like this, or this, years, nay decades, of torturing third year's has caught up to the field and they enjoy a slightly less than desirable reputation among medical students.

Also I don't understand what you mean by "proceduralists." Sorry to be a bother.

• Surgeons = commander of the Operating Room ship, you are cutting a patient open while they are on life support. More a way of life than a medical speciality, which is why people often recommend surgeon vs non-surgeon as the first step to deciding your speciality.
• Proceduralist = You are lightly sedating the patient with midazolam/fentanyl or an epidural while you tinker with some part of the body that is your area of expertise. Involves lots of scopes (GI, Pulm), stents (cards), 10 blades (derm), lasers (optho), chest tubes/intubations (EM), and IV's/epidurals/intubations (anesthesia).
• Thinkers = patient's are icky, minimize touching at all costs.

 

[BigTumor]

Just poking the bear -- I actually enjoyed my Ob/gyn rotation, but as you can see on threads like this, or this, years, nay decades, of torturing third year's has caught up to the field and they enjoy a slightly less than desirable reputation among medical students.

• Surgeons = commander of the Operating Room ship, you are cutting a patient open while they are on life support. More a way of life than a medical speciality, which is why people often recommend surgeon vs non-surgeon as the first step to deciding your speciality.
• Proceduralist = You are lightly sedating the patient with midazolam/fentanyl or an epidural while you tinker with some part of the body that is your area of expertise. Involves lots of scopes (GI, Pulm), stents (cards), 10 blades (derm), lasers (optho), chest tubes/intubations (EM), and IV's/epidurals/intubations (anesthesia).
• Thinkers = patient's are icky, minimize touching at all costs.

And note that by that definition of "proceduralist" OB/GYN does not fit the bill.

 

[NWwildcat2013]

And note that by that definition of "proceduralist" OB/GYN does not fit the bill.

Yeah if urologists are classified as surgeons in this scheme then OBGYN should be too.

 

[Law2Doc]

Break it down: Decide surgeon vs proceduralist vs thinker.

1. Surgeons
   • Brutal hours: Gen Surg, Neurosurg, Ortho
   • Life after residency: ENT, Uro, Plastics
2. Proceduralists
   • Like clinic: GI, Pulm, Interverntional cards, Opthalmology, Derm
   • Hate clinic: EM, IR, Anesthesia
   • Hate everyone and everything: Ob/gyn
3. Thinkers
   • Like kids: Peds
   • Hate kids: Medicine
   • Like everyone: FM
   • Hate everyone: Path
   • Hate work/Love life: PM&R, Psych

If you find yourself in one of these subcategories with multiple fields in play, stratify by:

1) Intellectual interest in that speciality
2) Ability to get into the speciality
3) "Finding your people" (ie you fit in with the people in that speciality)
4) Pay/lifestyle combo of that speciality
​

Bear in mind that this post is written with internal biases against certain "brutal hour" fields and OBGYN personalities, and steers one toward fields like PM&R or Psych. We could all rewrite it to make fields like Psych look like the seventh circle of hell and surgeons actually fixing things while the other fields sat around twiddling their thumbs. I've even seen tongue in cheek charts like this that even make EVERY field look horrible.

Sorry OP you aren't going to get a nice easy decision tree to follow to get to your chosen field. You should however decide if you are looking for a path where you spend most of your time gloved up and doing invasive things to patients versus spending most of your time talking to and examining patients. That will narrow the scope considerably. After that it's really about checking out each field on rotations or shadowing a few hours a week in your "spare" time, and deciding "yeah I could see myself doing that" or "gosh that job looks tedious/frustrating -- I would hate that life". And then go with your gut and don't look back. To some extent the mentors/role models you'll meet on the way will influence you one way or another. You may like a field going in but find the attendings aren't the kind of personalities you'd want as peers, or vice versa.

 

[NickNaylor]

Just poking the bear -- I actually enjoyed my Ob/gyn rotation, but as you can see on threads like this, or this, years, nay decades, of torturing third year's has caught up to the field and they enjoy a slightly less than desirable reputation among medical students.

I agree. I actually liked a lot of OB/GYN and was particularly drawn to the mix of clinic and surgery. But I don't think I've ever met such a miserable group of people in my life.

 

[akwho]

Bear in mind that this post is written with internal biases against certain "brutal hour" fields and OBGYN personalities, and steers one toward fields like PM&R or Psych. We could all rewrite it to make fields like Psych look like the seventh circle of hell and surgeons actually fixing things while the other fields sat around twiddling their thumbs. I've even seen tongue in cheek charts like this that even make EVERY field look horrible.

Sorry OP you aren't going to get a nice easy decision tree to follow to get to your chosen field. You should however decide if you are looking for a path where you spend most of your time gloved up and doing invasive things to patients versus spending most of your time talking to and examining patients. That will narrow the scope considerably. After that it's really about checking out each field on rotations or shadowing a few hours a week in your "spare" time, and deciding "yeah I could see myself doing that" or "gosh that job looks tedious/frustrating -- I would hate that life". And then go with your gut and don't look back. To some extent the mentors/role models you'll meet on the way will influence you one way or another. You may like a field going in but find the attendings aren't the kind of personalities you'd want as peers, or vice versa.

Good advice. Can't beat shadowing in each field of interest 1st and 2nd year, as you won't get time to see all the fields 3rd year.

I just created a logic tree that was similar to how I explored my speciality choices, since it felt real, I think it resonated with people. It's certainly not the only way to choose a speciality, but it's definitely better than a stupid online speciality selector like OP was using. I'm actually in a "brutal hours" field, and would never consider going into PM&R/Psych, but I can certainly admire the lifestyle they've carved out for themselves.