Choosing a specialty

[Cold Penguin]

When you guys choose a specialty, how do you navigate your choices and narrow down to your top choice? Also, is anyone aware of any health-risk report concering the specialties chosen by MDs? (i.e. x-ray bad for radiologists (thereby causing cancer and possibly birth defect), frequent depression among psychiatrists, etc) What are the general stereotypes concerning a few of the specialties, and how do you plan on going by choosing one? (or those of you who already have one in your mind, what was your deciding factor?)

I just want to see what you guys think about choosing a specialty in general (or in depth).

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[vtucci]

I would suggest you pick up Iserson's Guide to Getting a Residency. It is the best guide currently available and gives a nice breakdown on the different specialties and personality traits involved in the "typical" physicians who practice those specialties.

Be careful about putting too much stock in stereotypes. Yes, there may be physicians with similar personality traits in a given field but there are always exceptions. Nonetheless, if you want a few...

For example, Emergency Physicians tend to be quick thinkers (always thinking on their feet), creative problem solvers and decisive. They get bored easily, like using their hands and dealing with life-threatening problems across a diverse population. They thrive in crisis mode. Many EM docs have a refined sense of humor that can fit even the most macabre situation. They are the quintessential jack-of-all trades, knowing a little about a lot of fields of medicine instead of alot about just one. On the negative side, some people may think that EM docs are abrupt and callous and to have a bad case of "ADD".

Surgeons are also decisive, authorative and extremely hard working (with some attendings still working 80+ hours per week). The best surgeons are usually methodical and detail-oriented but can deal with crisis well. Many surgical subspecialtists thrive on being the best at doing one particular thing- they thrive on being cutting edge (no pun intended) and some of the more advanced interventions can appeal to their intellectual sides. They can spend years refining a procedure and perform the same surgery hundreds of time in a year. Let's not forget the prestige and money that comes along with the title surgeon. On the negative side, many surgeons are accused of having a God complex and lacking empathy.

Family docs depending on the type of practice can know the intimate details of an entire family's history. Many docs go into this field for patient continuity-- the ability to follow a patient for years. There is also a huge preventative aspect to this job. They are the gatekeepers to the specialties. They can assess whether a patient needs to see a cardiologist or surgeon to fix a hernia. Considered by many to be a warmer and fuzzier specialty (although with the mandated 30 patients per day by HMOs this may well change). The pay and prestige involved in family practice is not nearly as high as many specialties.

These are only three fields (and they have subspecialties within them as well). What is important to you? As for choosing what field you want to enter, consider:

1. How important is it to you to have continuity of patient care?
2. Are you interested in preventive measures?
3. Do you want to treat diverse populations (in terms of age and/or ethnicities/race and/or medical conditions) or become an expert in just one (kids or kids with cancer)?
4. How interested are you in performing complicated or technical procedures?
5. Do you want to be in a specific setting (i.e., hospital, emergency department, office practice, rural, urban etc)?
6. Do you want to see immediate results of your work or are you comfortable (or prefer) with a longer term treatment for your patients (i.e., Emergency Medicine vs. Psych)?

Some students know what specialty they want to enter before medical school but most do not and decide during their third year when they get a taste of the different fields.

 

[RxnMan]

When you guys choose a specialty, how do you navigate your choices and narrow down to your top choice? Also, is anyone aware of any health-risk report concering the specialties chosen by MDs? (i.e. x-ray bad for radiologists (thereby causing cancer and possibly birth defect), frequent depression among psychiatrists, etc) What are the general stereotypes concerning a few of the specialties, and how do you plan on going by choosing one? (or those of you who already have one in your mind, what was your deciding factor?)

I just want to see what you guys think about choosing a specialty in general (or in depth).

Try volunteering and shadowing a few docs in the specialities you're interested in. Nothing like empirical evidence.

This experience is also built-into med school. It's called 3rd year.

Random specialities quotes:

Radiologist = shadow-reader
Never specialize in an organ that can be replaced.

If you're interested in knowing more about ER humor (which is really good), check out this thread.

 

[DarksideAllstar]

This experience is also built-into med school. It's called 3rd year.

This experience can be woefully inadequate if your med school centers your third year entirely around primary care specialties (IM, FP, Peds), surgery, psych, and OB with little/no exposure to other fields or subspecialties. For me, this made the decision making process much more difficult than for others in my class who knew early on that they wanted to do well-baby checks for the rest of their careers.

 

[RxnMan]

This experience can be woefully inadequate if your med school centers your third year entirely around primary care specialties (IM, FP, Peds), surgery, psych, and OB with little/no exposure to other fields or subspecialties. For me, this made the decision making process much more difficult than for others in my class who knew early on that they wanted to do well-baby checks for the rest of their careers.

My research into the subject show that most schools won't let you do elective (i.e. speciality) rotations until 4th year.

But then again, it's not like you can't talk to a physician when you're MSI-MII - you have plenty of time to shadow folks. Or join an interest club (FP, Surgery Club, EM Interest, etc).

 

[Dunce]

This experience can be woefully inadequate if your med school centers your third year entirely around primary care specialties (IM, FP, Peds), surgery, psych, and OB with little/no exposure to other fields or subspecialties. For me, this made the decision making process much more difficult than for others in my class who knew early on that they wanted to do well-baby checks for the rest of their careers.

Amen.

For third year, my school has us stuck in 8 week rotations on each of the "big six" that you mentioned with ZERO time for any electives. Sucks for those of us who want to at least entertain the idea of considering a more specialized career.

 

[Biscuit799]

This experience can be woefully inadequate if your med school centers your third year entirely around primary care specialties (IM, FP, Peds), surgery, psych, and OB with little/no exposure to other fields or subspecialties. For me, this made the decision making process much more difficult than for others in my class who knew early on that they wanted to do well-baby checks for the rest of their careers.

In addition, many students may make a career decision based on their experience in a rotation. This is not necessarily a good decision: just because you had a good experience with really great doctors doesn't mean that you like that specialty, just that you had a really great experience.

 

[Darko]

I'd also recommend this medical specialty quiz to help you get started. Use it to find out what would some good fields for you to enter -- and what won't -- so you at least have a starting point. Then, like RxnMan was saying, shadow physicians and join interest clubs of the specialties that look compatible with your interests. I wouldn't rely on your third year rotations to tell you what you should go into. But you can learn certain useful things about yourself, like 'I hate old people,' or 'doing the same thing every day is boring.'

Medical school student affairs offices have pretty decent resources too -- I'd give the office at your school a call.

 

[drdoctor]

so is it important to shadow during the first two years? Is 3rd year enough time to make such an important decision?

 

[RxnMan]

so is it important to shadow during the first two years? Is 3rd year enough time to make such an important decision?

Well, you want to be able to make an informed decision. 3rd year will be taken up by rotations that (esp. for the posters above,) may not provide the experience you want, so you need to get that experience elsewhere.

But don't worry, we'll get a lot of this speciality-selection info at our orientation.

 

[Cold Penguin]

When you look for a doctor who lets you do the shadowing, how do you go by doing it? First of all, during your 1M and 2M, can you afford any time shadowing? Also, if you find one, will that be once a week, every other week, once a month? However often you do it, will that be enough time to get the firm grasp of how to go by choosing a specialty?

Also, what are the specialties post-bac students (who are starting their med school in 30s ) are likely recommended to avoid? (i.e. specialties that don't like old student docs, etc)

 

[Vox Animo]

I took that specialty test twice, and arrived at the same thing as my number one, and everything else accoordingly. Weird.

 

[AmoryBlaine]

I'd also recommend this medical specialty quiz to help you get started. Use it to find out what would some good fields for you to enter -- and what won't -- so you at least have a starting point. Then, like RxnMan was saying, shadow physicians and join interest clubs of the specialties that look compatible with your interests. I wouldn't rely on your third year rotations to tell you what you should go into. But you can learn certain useful things about yourself, like 'I hate old people,' or 'doing the same thing every day is boring.'

Medical school student affairs offices have pretty decent resources too -- I'd give the office at your school a call.

That test is kind of cool, but it is really geared towards the student who was had alot of clinical experience (as a 3rd/4th year medical student, not working as a tech in undergrad). You can't really answer alot of those questions until you've seen it being done with some sort of perspective.

Take all of your specialty interests with a grain of salt, you never know what you will love (or hate) as an M3.

 

[jocg27]

I would suggest you pick up Iserson's Guide to Getting a Residency. It is the best guide currently available and gives a nice breakdown on the different specialties and personality traits involved in the "typical" physicians who practice those specialties.

Be careful about putting too much stock in stereotypes. Yes, there may be physicians with similar personality traits in a given field but there are always exceptions. Nonetheless, if you want a few...

.

This is good, also Lange's guide, Choosing a Medical Specialty.

 

[H_Caulfield]

I've for some time been quite set on neurosurgery because....well...because it's neurosurgery. It's fascinating, and I do want my job to comprise the largest part of my life.

Seriously, what most people seem to do is just decide on what they're most interested in, and then on what kind of lifestyle they want, and then find the specialty that strikes the best compromise between the two.

Note that most of the lifestyle fields make for a rather see-through decision (unless you're rather abnormally adept at convincing people that eczema and acne are more interesting than the cardiovascular system). But then you could always just say that you're a "doctor," and leave it at that.

 

[phill_stone MD]

here are a few 'statistics'... i dont know where they are from, but ive heard them many different places. Some may be popular opinion. Some are from studies conducted by the ama. and they seem very true, anyway

dual MD households w/ both bc in psychiatry have the highsest divorce rate among physicians: 50%. yeah that means 1 in 2 couples!

average life expectancey of nuerosurgeons: 55. Reason: Stress. Source: almost 100% sure it was from something ben carson said, after he was diagnosed w/ prostate cancer. if you dont know who ben carson is, and your interested in neurosurgey, get a new career.

most surgeons are jerks.

most surgeons dont even know their kids.

thats all 4 now, will remember more later.

easy on the criticizing ppl...lol

 

[Vox Animo]

here are a few 'statistics'... i dont know where they are from, but ive heard them many different places. Some may be popular opinion. Some are from studies conducted by the ama. and they seem very true, anyway

dual MD households w/ both bc in psychiatry have the highsest divorce rate among physicians: 50%. yeah that means 1 in 2 couples!

average life expectancey of nuerosurgeons: 55. Reason: Stress. Source: almost 100% sure it was from something ben carson said, after he was diagnosed w/ prostate cancer. if you dont know who ben carson is, and your interested in neurosurgey, get a new career.

most surgeons are jerks.

most surgeons dont even know their kids.

thats all 4 now, will remember more later.

easy on the criticizing ppl...lol

Did you know that 62% of statistics are made up on the spot?


just messin with ya

 

[vtucci]

When you look for a doctor who lets you do the shadowing, how do you go by doing it? First of all, during your 1M and 2M, can you afford any time shadowing? Also, if you find one, will that be once a week, every other week, once a month? However often you do it, will that be enough time to get the firm grasp of how to go by choosing a specialty?

Also, what are the specialties post-bac students (who are starting their med school in 30s ) are likely recommended to avoid? (i.e. specialties that don't like old student docs, etc)

I was a post-bac and will be 30 in a couple of weeks. Most of the older students in our class are EM bound. Most of us want to avoid surgery and Ob/Gyn because of lifestyle issues. There are exceptions of course and it also depends male v. female and whether you already have or want children.

 

[Cold Penguin]

I am a post-bac and will be 30 in a couple of weeks. Most of the older students in our class are EM bound. Most of us want to avoid surgery and Ob/Gyn because of lifestyle issues. There are exceptions of course and it also depends male v. female and whether you already have or want children.

Could you elaborate little bit more on female vs male and no children vs. having children when it comes to the matter of choosing a specialty? I know this sounds really cliche, but I am curious of the on-going common trend among med students and post-bac residents. Thanks.

 

[vtucci]

When you look for a doctor who lets you do the shadowing, how do you go by doing it? First of all, during your 1M and 2M, can you afford any time shadowing? Also, if you find one, will that be once a week, every other week, once a month? However often you do it, will that be enough time to get the firm grasp of how to go by choosing a specialty?

Your medical school may have a program where you are assigned to a doctor your first and/or second year. Mine does and it is our Longitudinal clinical experience. If you want to shadow a doc, you have options. What are you comfortable with? You can e-mail the doc and introduce yourself as an M1 interested in shadowing them and learning more about their field. You will have a few hours of week to do this. It does not have to be every week. It can be every few weeks. Do you want to do an 8 hour shift in the ER? Or call with an IM resident? Or office visits with a pediatrician?

Before you start thinking about specialty, look at your own personality and what things will make you happy and which will annoy you. Example, I can be hyper, outgoing, like high paced activity, get bored easily, want new challenges. I am EM bound all the way. Neurosurgery would be a terrible match for me. To me, that would be doing the same thing day after day. Some people need that- to know exactly what they are going to do each day when they get in (with the exception of trauma/anerusym etc). They want to be experts in one field.

 

[Cold Penguin]

Thanks for your thoughtful reply. It seems like shadowing during M1 and M2 will be the way to go. What percentage of M1 and M2 does shadowing on their own, and how common is this? ( It will be embarrassing to be one of many M1 emailing the radiology department for shadowing on day 1?)

When you look for a doctor who lets you do the shadowing, how do you go by doing it? First of all, during your 1M and 2M, can you afford any time shadowing? Also, if you find one, will that be once a week, every other week, once a month? However often you do it, will that be enough time to get the firm grasp of how to go by choosing a specialty?

Your medical school may have a program where you are assigned to a doctor your first and/or second year. Mine does and it is our Longitudinal clinical experience. If you want to shadow a doc, you have options. What are you comfortable with? You can e-mail the doc and introduce yourself as an M1 interested in shadowing them and learning more about their field. You will have a few hours of week to do this. It does not have to be every week. It can be every few weeks. Do you want to do an 8 hour shift in the ER? Or call with an IM resident? Or office visits with a pediatrician?

Before you start thinking about specialty, look at your own personality and what things will make you happy and which will annoy you. Example, I can be hyper, outgoing, like high paced activity, get bored easily, want new challenges. I am EM bound all the way. Neurosurgery would be a terrible match for me. To me, that would be doing the same thing day after day. Some people need that- to know exactly what they are going to do each day when they get in (with the exception of trauma/anerusym etc). They want to be experts in one field.

 

[vtucci]

It is not common for M1 and M2 to be shadowing right off the bat. Many students do not know what specialties they are interested in and are concerned about how they will handle the courseload before doing any activities including shadowing. I doubt that you will encounter many students going to the same doc at the same time. There are more than one radiologists in hospital departments.

Also you should check out the specialty interest groups at your medical school, i.e., Cardiology Interest Group. They may have a shadowing plan already in place with docs at the affiliated hospital and all you have to do is sign up.

As for the children/non-children post-bac debate.... First up, not all older students want children ever. These individuals do not need to take lifestyle issues into as much consideration as older students who want to have children. They are more like our younger colleagues in terms of choosing speecialties. Those who want children tend to look more at lifestyle friendly specialties (Derm, Radiology, Path, Psych, anesthesia, EM) and avoid what are usually considered the more malignant specialties (Surg, OB, IM- depending on location and hospital- some IM programs are great but buyer must beware). FP among older students often splits based on whether someone is motivated by money or not.

It may not seem fair to generalize but most women do not have children in medical school or residency. It seems much easier for my male classmates to have kids particularly when their spouse is a stay-at-home mom. For the women who do decide to have a baby during med school or residency, Some will plan it out to a tea so they deliver in second year or fourth. Being on the heavy end of pregnancy doing your surgical rotation in third year is not a recipe for happiness.

With respect to me, I want to have a child before I am 40 and may have a child during residency (I would be between 35-38). I am planning to go into EM where the hours during residency are usually well under the 80 hour max (except in Ob and trauma and neuro surg). EM has no call. However, if you are the type of person who does not deal well with night shifts, overnights and rotating schedules, EM may not be for you. The hours are not the main reason I love EM though. It is just an added benefit like the icing on an already fabulous cake.

 

[Hard24Get]

I gotta keep beating this drum until everyone knows about it. AAMC Careers in Medicine was developed just for us by the governing body of medicine.

this website has links to career resources as well as to Careers in Medicine itself. It offers self-assessment tests, detailed info on many specialties, questions to ask physicians in the field you are interested in, help with matching, and more. To start your own profile, you need a code from your school, but you can get it in the course of a 2 minute telephone call.

Also, here is a link to a fun powerpoint presentation that helps you find out what your personality type is and gives lists of potentially great specialties for your personality type:

http://www.med.mun.ca/medcareers/do...al Specialties_Ada Shave_complete version.ppt

This quiz will tell you your personality:
http://www.humanmetrics.com/cgi-win/JTypes1.htm

Have fun!

 

[randomedstudent]

so is it important to shadow during the first two years? Is 3rd year enough time to make such an important decision?

The short answer is no, in many cases 3rd year is not enough time to choose a specialty. I only wish my school would have made this a little clearer when I was a 1st/2nd year and maybe now I wouldn't be a 4th year who still doesn't know what they want to do. At my school the mantra during years 1 and 2 was "focus on your courses, you will have plenty of time to experience the specialties during 3rd year", ie. don't waste time shadowing now, just study. Woefully bad advice....as stated by others, this will only work if you A)already know for sure what you want to do or B) are lucky enough to want to do one of the "big 6" that we are exposed to during 3rd year. Unfortunately that leaves out a huge chunk of people who are left scrambling in July and August of 4th year, trying out several other specialties before deciding. And to those who recommend shadowing doctors during all of our "free time" during 3rd (I don't know where they go to school, but I know that psych was probably my only rotation where I had any time during which I could have shadowed), following a doctor around for a few days or even a week is probably not going to give you enough insight to truly know whether the specialty is right for you or not. Bottom line - start thinking about specialties in 1st year. I'm serious, I wish I had, because know I am going crazy trying to figure this all out.

 

[Cold Penguin]

I agree with you randomstudent. I am not yet where you are, but my hunch tells me that I am not going to have what people call "plenty of time later on" when it comes to the matter of figuring out my specialty. By the time I sit down and start figuring it out in my 4th year, I am going to start regretting, "oh I wish I had done this and done that. Oh, I don't have this and that."

So, I am going to find my own ways to explore my future specialty. It's funny in college that people gave you strage looks when you told people that you were pre-med. The very same thing happens when conscientious med-school bound or med students are eager to figure out how to go by figuring out their specialty early on. Other med students look at you and say, "get a break now," but I don't think so. I gotta do what I need to do no matter who says what

I think people are jealous that I can think ahead of time. I don't know. Am I crazy? (Even if I am crazy, I am still going to work on deciding my specialty early on)

The short answer is no, in many cases 3rd year is not enough time to choose a specialty. I only wish my school would have made this a little clearer when I was a 1st/2nd year and maybe now I wouldn't be a 4th year who still doesn't know what they want to do. At my school the mantra during years 1 and 2 was "focus on your courses, you will have plenty of time to experience the specialties during 3rd year", ie. don't waste time shadowing now, just study. Woefully bad advice....as stated by others, this will only work if you A)already know for sure what you want to do or B) are lucky enough to want to do one of the "big 6" that we are exposed to during 3rd year. Unfortunately that leaves out a huge chunk of people who are left scrambling in July and August of 4th year, trying out several other specialties before deciding. And to those who recommend shadowing doctors during all of our "free time" during 3rd (I don't know where they go to school, but I know that psych was probably my only rotation where I had any time during which I could have shadowed), following a doctor around for a few days or even a week is probably not going to give you enough insight to truly know whether the specialty is right for you or not. Bottom line - start thinking about specialties in 1st year. I'm serious, I wish I had, because know I am going crazy trying to figure this all out.

 

[RxnMan]

...Am I crazy? (Even if I am crazy, I am still going to work on deciding my specialty early on)

No, I think the same thoughts. But don't drive yourself crazy if you don't know what you want to do right away. There is time, especially since you're thinking about it now. I'd say explore your options, think about what you like, but be open to change.