Choosing your specialty

[AnnK]

Halfway through my third year I think Im learning what I like, and (mostly) dont like. I still have no idea what feild to get into. Id love any advice on fields that seem to mesh well with these interests in no particular order...

1. I like clinic/regular hours (some call okay but Id prefer to avoid too much).
2. Id like to specialize/be an expert.
3. The more thinking the better.
4. I dont like surgery but some procedures/special technology would be good.
5. I like long term or at least regular patient contact during treatment.
6. I dont have any real patient population preference - variety would be good.

Anyone have the answer for me?

Thanks!!!
Ann

 

[Goofy]

Originally posted by AnnK:
Halfway through my third year I think Im learning what I like, and (mostly) dont like. I still have no idea what feild to get into. Id love any advice on fields that seem to mesh well with these interests in no particular order...

1. I like clinic/regular hours (some call okay but Id prefer to avoid too much).
2. Id like to specialize/be an expert.
3. The more thinking the better.
4. I dont like surgery but some procedures/special technology would be good.
5. I like long term or at least regular patient contact during treatment.
6. I dont have any real patient population preference - variety would be good.

Anyone have the answer for me?

Thanks!!!
Ann

Sounds like you would be an excellent match for one of the medicine subspecialties like Cardiology, G.I., pulmonology, or Hem/Onc

 

[Stinky T]

I agree with Klebsiella, Cardiology would be a good fit given your interests and PhD. Electrophysiology or Interventional Cardiology might be areas within Cardiology to consider as well. Good luck with your decision.

 

[AnnK]

Thanks alot for you thoughts! I really appreciate the input. Ive thought about the medicine subspecialties, esp heme/onc. I dont really like the thought of doing the medicine residency but I suppose I could survive that.
Can you shorten the gen medicine by a year if you pick your specialty right away? I thought that the 5 years could be condensed to 4. Is this true? Im such a wimp. Thats what I get for being old (sort of). I dont know any thing about electophysiology/cardiology. Sounds interesting too.

Thanks again!!
Ann

 

[Goofy]

Originally posted by AnnK:
<strong>Thanks alot for you thoughts! I really appreciate the input. Ive thought about the medicine subspecialties, esp heme/onc. I dont really like the thought of doing the medicine residency but I suppose I could survive that.
Can you shorten the gen medicine by a year if you pick your specialty right away? I thought that the 5 years could be condensed to 4. Is this true? Im such a wimp. Thats what I get for being old (sort of). I dont know any thing about electophysiology/cardiology. Sounds interesting too.

Thanks again!!
Ann</strong><hr></blockquote>

Electrophysiology is a fascinating branch of cardiology. You get to do a lot invasive procedures including ep studies as well as catheter ablations an the like.

As far as combining a fellowship with medicine residency, I wouldn't get your hopes up. While such a combination has been done before in highly unusual situations, it is extremely rare. Cardiology is an especially competitive field, and there is little motivation to reduce the number of years of training for a particular applicant.

 

[jimjones]

Neurology. 4 years, lots of thinking. Lots of expertise.

 

[droliver]

Cardiology is not something you would like if you wish to avoid call. After surgeons, cardiologists are at the hospital the most at all hours of the day.

 

[droliver]

Just a thought....

A few of the medical specialties like Endocrine, Nephrology,Neurology, and Heme-Onc might be up your alley.

 

[GreatPumpkin]

Path fits all but one of your choices. You should consider doing a rotation. See what you think. It really is a fun residency and specialty.

The internal med route doesn't fit your first requirement nearly as well as path. I work regular hours, have almost all weekends off and take call from home. And, I am an intern

 

[jimjones]

Pumpkin: Is AnnK's 5th requirement satisfied with pathology?

 

[Voxel]

Have you thought about Dermatology? I think it may be a good fit. Just make sure you honor every thing possible, score in the top 5-10% on Step I, and do derm research, make good connections/good LOR, and pray. 4 year residency (int med-1yr + then 3yr derm). Also, under the medicine specialties strongly consider Rheumatology and Allergy&Immunology (5 years- 3 int med, 2yrs rheum/A&I fellowship). Essentially no/v little call for either (although rheum has more) and each do some procedures such as tapping joints for Rheum, and fiber optic scoping of the nasal passage for A&I.

Also consider GI (some emergent call, but not nearly as bad as cardiology), Nephrology (not many procedures that you do yourself), and Endocrinology (not many/if any procedures, one needs to be in an academic center to do mostly Endocrine otherwise mostly primary care).

Also, if you do not mind giving up patient contact, radiology and pathology maybe a good fit.

 

[Stinky T]

Originally posted by AnnK:
I dont really like the thought of doing the medicine residency but I suppose I could survive that.
Ann

I've heard that so many times from medical students who are interested in one of the medicine subspecialties. I'd have to say that doing a medicine residency is probably one of the biggest drawbacks to doing Heme/Onc, Cards, or any other medicine subspecialty. I couldn't even bring myself to do a preliminary year in medicine.

Droliver is right, some Cardiologists are at the hospital ALL the time -- especially the fellows. There are areas of Cardiology, especially if you plan to go into academics and/or research, which provide for a much more pleasant lifestyle/call schedule. I've met many MD/PhD students who have found Cardiology to be a perfect fit for them. By the way, Neurology is not a subspecialty of medicine.

 

[theD.O.C.]

What about PM&R/anesthesiology then doing a pain managment fellowship? pain mgt is clinic based, you're an expert (an expert on pain, wow I like the sound of that!), there are lots of procedures, and you definately have alot of patient contact. Best of all you don't have to go through a painful Internal medicine residency to get there!

 

[GreatPumpkin]

Originally posted by jimjones:
<strong>Pumpkin: Is AnnK's 5th requirement satisfied with pathology?</strong><hr></blockquote>

Uhh, i said all but one if you read my post. It is pretty obvious which one.

But, then again a pathologist who specializes in blood bank/apheresis does have some long term patient contact.

 

[Sandpaper]

Originally posted by AnnK:
<strong>Halfway through my third year I think Im learning what I like, and (mostly) dont like. I still have no idea what feild to get into. Id love any advice on fields that seem to mesh well with these interests in no particular order...

1. I like clinic/regular hours (some call okay but Id prefer to avoid too much).
2. Id like to specialize/be an expert.
3. The more thinking the better.
4. I dont like surgery but some procedures/special technology would be good.
5. I like long term or at least regular patient contact during treatment.
6. I dont have any real patient population preference - variety would be good.

Anyone have the answer for me?

Thanks!!!
Ann</strong><hr></blockquote>
So you wanna be an anesthesiologist eh? Regular hours? Check. Specialization, expert? Check. Thinking? Err, check. Procedures? Check. Patient contact during treatment? Check. Variety in patient population? Check. Damn, everybody wants to pass gas these days.

 

[droliver]

Sandpaper,

Regular hours? Anesthesia is one of the least regular hours fields with lots of call (outpatient pain-mgt. practices excluded)

Patient contact? Most of my friends in the field go into it (among other reasons)for the LACK of patient contact & followup. And in regards to pain-mangaement,the prospect of chronic followup with a number of the patients is one of the most unenjoyable parts of the field

 

[pags]

I think Radiology would be good. I mean, good hours, you can do procedures, you can be an expert, you can think if you want, and with all the vacation (12 to 16 weeks) radiology jobs are offering nowadays, you can volunteer in the hospital for your patient contact.

 

[CoffeeCat]

radiology jobs are seriously offering 12 to 16 weeks vacation?! Sign me up!

 

[Sandpaper]

Originally posted by droliver:
<strong>Sandpaper,

Regular hours? Anesthesia is one of the least regular hours fields with lots of call (outpatient pain-mgt. practices excluded)

Patient contact? Most of my friends in the field go into it (among other reasons)for the LACK of patient contact & followup. And in regards to pain-mangaement,the prospect of chronic followup with a number of the patients is one of the most unenjoyable parts of the field</strong><hr></blockquote>

droliver, the regular hours and cushy call schedule depend on where you work and what group you get with. 7am-4pm is the norm around here, and the anesthesiologists in private practice don't even take calls or do weekends. And everybody gets every 6th week off. And oh, there's plenty of patient contact: they're just not aware of it, that's all.

 

[Jamier2]

Originally posted by Sandpaper:
<strong>And oh, there's plenty of patient contact: they're just not aware of it, that's all. </strong><hr></blockquote>

That's what I was thinking. At least they don't complain, huh?

 

[SimulD]

Question for the elders...

Say you want to do one of the medicine specialties like allergy, or cardiology, but you want to work with kids.

So, would I do a peds residency and then apply to one of those fellowships? Will I get a fellowship or is it super competitive?

Do you have to do research in a fellowship? Do you have to have research background?

Can I still do a little gen peds, too, or am I just doing allergies?

Well, thanks in advance,

Simul

 

[Leotigers]

Hey Simul,

You would do a Pediatrics residency followed by a fellowship in Allergy/Immunology or Cardiology. Some individuals can be accepted after two years if they are accepted through the American Board of Pediatrics Special Alternative Pathway procedure. The fellowships are competitive so it would be a good idea to get into a prestigious pediatrics residency program. This is not a must but having an influential program director is a plus. Many of the top peds residencies also have fellowships so it would be a definite advantage for you.

Research is not necessarily required in residency, but some program integrate it into the fellowship (more so in Pediatric Cardiology). You do not have to have a research background to apply to the fellowships but it probably helps.

Having worked with both Pediatric Allergists and Cardiologists, I would say that none (at least the ones I worked with in med school) do General Pediatrics. You will see why once you do a Peds rotation. If you really desire doing General Peds as well, there would be nothing to prevent you from doing so.

My classmate is doing her residency at Stanford and she absolutely loves it there. I also have a friend who did her residency at UCLA and was just offered their Heme/Onc fellowship. She had equally positive things to say about the Peds program at UCLA. If you ever decide to visit the greatest state in the world, you should consider doing rotations there. I hope this helps and this is about as much as someone not going into Peds knows.

 

[djmd]

Say you want to do one of the medicine specialties like allergy, or cardiology, but you want to work with kids. <hr></blockquote>

Well keep in mind that Peds cards it total different thant adult cards (I mean its kind of duh obvious, but its worth mentioning, dont mena to sound condisending)

On a more helpfull note.. I think that Allergy-Immuno actually doesn't mater as much if you do med vs peds...
I think they both work with a full spread...
I know meds to Allergy works with teenagers..

Might want to check on that, but I think thats correct... Hope that helps

-DjMd

 

[Sanman]

Not to digress, but how hard are the A&I, endocrinology, rheumatology, etc. fellowships to obtain from medicine and from peds. By the way stinky, no reccomendation of PM&R? Well, I guess we've discussed it to death anyhow.

 

[Voxel]

I think the hardest two fellowships in medicine are cardiology (1) and GI (2). I think rheumatology and endocrinology are relatively easy to get. I'm not sure about A&I, but I hear it may be increasing in popularity.

I guess we could throw PM&R into the list.

 

[jimjones]

posted December 11, 2001 04:49 PM
--------------------------------------------------------------------------------

quote:
--------------------------------------------------------------------------------
Originally posted by jimjones:
Pumpkin: Is AnnK's 5th requirement satisfied with pathology?
--------------------------------------------------------------------------------

Uhh, i said all but one if you read my post. It is pretty obvious which one.
<hr></blockquote>


Uhhhh, Errr..... OOOOOOOOOOOHHH. Yah, I guess that's right, sorry my friend.

 

[Stinky T]

Originally posted by Sanman:
By the way stinky, no reccomendation of PM&R?

Originally posted by Voxel:
I guess we could throw PM&R into the list.

I thought it went without saying.

Originally posted by theD.O.C.:
What about PM&R/anesthesiology then doing a pain managment fellowship? pain mgt is clinic based, you're an expert (an expert on pain, wow I like the sound of that!), there are lots of procedures, and you definately have alot of patient contact. Best of all you don't have to go through a painful Internal medicine residency to get there!

If you are interested in Pain Managment, but want a variety of patients and regular clinic hours, PM&R would definitely be worth considering.

In an orthopedic clinic setting, a Physiatrist could work with athletes doing sports medicine and the procedures associated with general medical orthopedics. This would be in addition to the Pain Managment procedures you would be doing. There is absolutely no call because anything emergent that is of an orthopedic nature is handled by the Orthopedic Surgeons. If you decide to do Anesthesia and then Pain Management, your time would be split between the OR and Pain Clinic.

I didn't really think this option would fit you because you had mentioned in another thread you wanted something with an academic bent to it. No matter which pathway you choose, there would be limited academics involved. There is ongoing research in Pain Management, but it isn't terribly exciting. The rehabilitation aspect of PM&R is more academic and there is a ton of research in TBI, SCI, Pediatric Rehab, Cardiac Rehab, etc. Focusing on this aspect of PM&R is less likely to fulfill one or two of your other criterias, however.

Oh, you wouldn't have to go through a painful Internal Medicine Residency to get you there either.

 

[AnnK]

Thanks so much for all the great replies! Lots of good food for thought. Im really too big on long term patient contact to consider, rads, path or anesthesia altho I think that they are really interesting.

I like the ideas of neurology and PM&R. Ill have to learn a little more about PM&R. I realy dont have a very good idea of what it involves. Do they do any procedures? Are there areas within PM and R to focus on?

Ive also thought about derm but im not sure about whether I would find it clinically interesting enough or not. Ill have to try to get more exposure.

Im also thinking of rad onc. Im a little concerned about getting into some of these small specialties.

Thanks again for all the ideas!!

Ann

 

[rad]

Before you consider derm remember that it is an extremely competitive field that requires some political connections. Better to avoid exposure at the risk of liking it. Neurology, PMR are good fields to consider.

 

[jimjones]

You should also consider your own personal stregnths and weaknesses. Eg, if you got a C in physics, and always struggled with physics, don't even consider rad onc. If you rocked at neuroscience in 2nd year, go for neurology, etc.

 

[rad]

I agree with jimjones about going into something you are strong at. I also think that if you are weak in physics you should NOT discount rad. onc or radiology. Physics is a very small part of the clinical practice of these fields. You are only required to pass a test on the basic principles during residency in order to become board eligble/certified.

 

[Goofy]

Originally posted by jimjones:
<strong>You should also consider your own personal stregnths and weaknesses. Eg, if you got a C in physics, and always struggled with physics, don't even consider rad onc. If you rocked at neuroscience in 2nd year, go for neurology, etc.</strong><hr></blockquote>


I see advice like this so often that I have to laugh. People are constantly shunned from doing what they love because they may have stumbled along the way. We are all human. I personally know dozens of people who failed college courses and ended up as AOA representatives of their school.

Take this advice and discard it. Doing poorly doesn't necessarily you wont like it. I was once told by a guidance counselor in high school that I would never amount to anything because of a poor literature grade. I went on to be valedictorian of my undergraduate class and then med school, go figure.

If your here, you can handle it, period! Never ever base your future prospects on a scholastic trail. Base it on what you love to do, you will be much happier. And never ever listen to a guidance counselor's advice. Alternatively, do exactly the opposite.

 

[Stinky T]

Originally posted by AnnK:
Thanks so much for all the great replies! Lots of good food for thought. Im really too big on long term patient contact to consider, rads, path or anesthesia altho I think that they are really interesting.

I like the ideas of neurology and PM&R. Ill have to learn a little more about PM&R. I realy dont have a very good idea of what it involves. Do they do any procedures? Are there areas within PM and R to focus on?

Ive also thought about derm but im not sure about whether I would find it clinically interesting enough or not. Ill have to try to get more exposure.

Im also thinking of rad onc. Im a little concerned about getting into some of these small specialties.

Thanks again for all the ideas!!

Ann

Yes, there are many procedures that Physiatrists do. Procedures include EMGs, joint injections, SNRBs (Selective Nerve Root Blocks), Botox injections, phenol blocks, myofascial trigger point injections, discograms, IDETs (Intradiscal Electrothermal Annuloplasty), epidural injections, etc. The Division of Spine & Sports Care at the University of Virginia provides a good summary of some of the spinal procedures a Physiatrist would do:

http://www.med.virginia.edu/medicine/clinical/phys-med-rehab/pmrspine.html

Here's a list of some of the fellowships you can do through PM&R:

1. Interventional Pain Management (through Anesthesia or PM&R)
2. Sports/Orthopedic Medicine
3. Sports & Interventional Spine
4. Cardiac Rehabilitation
5. Pulmonary Rehabilitation
6. Traumatic Brain Injury
7. Spinal Cord Injury
8. Electrodiagnostic Medicine
9. Pediatric Rehabilitation

 

[jimjones]

I see advice like this so often that I have to laugh. People are constantly shunned from doing what they love because they may have stumbled along the way. We are all human. I personally know dozens of people who failed college courses and ended up as AOA representatives of their school.

Take this advice and discard it. Doing poorly doesn't necessarily you wont like it. I was once told by a guidance counselor in high school that I would never amount to anything because of a poor literature grade. I went on to be valedictorian of my undergraduate class and then med school, go figure.

If your here, you can handle it, period! Never ever base your future prospects on a scholastic trail. Base it on what you love to do, you will be much happier. And never ever listen to a guidance counselor's advice. Alternatively, do exactly the opposite.

I love it when I hear this sort of crap. The "Oh, you can be anything you want to be... even the president" Give me a break. I was only implying that if they are haveing a tough time choosing, lean to something they are good at.

I work full time at a huge cancer clinic and talk every day to rad oncs. They have told me that they chose that field because they were very interested in isotope/quantum physics, and they had a very good understanding of these principles. I don't think someone would enjoy rad onc as much if they did not enjoy and were strong in theoretical physics.

I know this would be true for myself, everyone is different. My advice would be not to discard anyone's opinion, simply add everything up and decide what applies to you the most.

 

[jimjones]

Also, I want to say that what I meant was that people can still do fields they struggle in, but might more often be happier at something they have natural talent for. I am hopeless with all things mechanical. If I tried really hard, could I ever be a mechanic or an engineer? Sure. But I probably would not enjoy it as much. I think I am good at talking with people about their problems, so I might do Psychiatry. I know that I'll probably find the most enjoyment deploying my talents into my career.

 

[Goofy]

Originally posted by jimjones:
<strong>

I love it when I hear this sort of crap. The "Oh, you can be anything you want to be... even the president" Give me a break. I was only implying that if they are haveing a tough time choosing, lean to something they are good at.

I work full time at a huge cancer clinic and talk every day to rad oncs. They have told me that they chose that field because they were very interested in isotope/quantum physics, and they had a very good understanding of these principles. I don't think someone would enjoy rad onc as much if they did not enjoy and were strong in theoretical physics.

I know this would be true for myself, everyone is different. My advice would be not to discard anyone's opinion, simply add everything up and decide what applies to you the most.</strong><hr></blockquote>

When you disparrage others, you are only disparraging yourself.

I fully understood the point of your post. My point should have been obvious.

Further, the idea that one should 'do what they are good at' is absolutely assanine. I am great at flipping burgers, should I quit my day job and hit the employment lines at mcdonalds. Just because someone may or may not have developed specific technical skills doesn't mean they should avoid a specialty. The meter is what you love to do, not what you are good at. You can become good at something, especially if you love doing it. If you are good at what you love, more power to you. But certainly don't do something 'you are good at' if you simply don't enjoy doing it.

 

[Goofy]

Originally posted by jimjones:
<strong>Also, I want to say that what I meant was that people can still do fields they struggle in, but might more often be happier at something they have natural talent for. I am hopeless with all things mechanical. If I tried really hard, could I ever be a mechanic or an engineer? Sure. But I probably would not enjoy it as much. I think I am good at talking with people about their problems, so I might do Psychiatry. I know that I'll probably find the most enjoyment deploying my talents into my career.</strong><hr></blockquote>

Fair enough. But in medicine, many often go towards things they are naturally 'good' at but don't necessarily enjoy. This amounts to a lifetime of doing something they are quite handy at, but hate nonetheless. It is possible to become proficient in disciplines with enough effort, especially at this level of education.

 

[Sonya]

How does psychiatry fit into the picture here in terms of criteria like what ann mentioned?

also, let's add to this a few different criteria to discuss specialties on:
Making a serious impact on people. I'd like to do something, where it would really help someone. Like in psych, and many other chronic illness, they are in a lot physical/mental pain. and, I think it would feel really good to get them out of this situation, and i would be appreciated.

Particularly, how would psych fit in terms of requiring thinking and intellectually stimulating. I'm guessing it'd be low in terms of that. How's neuro-psych different from psych?

also, i was shadowing a otolaryngologist last year. I felt that a lot of the medicine was "more of the same". you know, all the patients were pretty much the same and could be classified into 5 to ten types of diseases, and were all given pretty much the same type of treatment. Occasionally there was something different, but mostly it's all repeat. I think that would get boring... i'm not sure though.

are many specialties like this? this doctor was really specialized... mostly all dizzy patients. Is it more likely to be "more of the same" in a general field vs. a specialized field.

wow, thanks for all the info. it's told me a lot.

 

[rad]

"Like in psych, and many other chronic illness, they are in a lot physical/mental pain. and, I think it would feel really good to get them out of this situation, and i would be appreciated."

Trust me, you are not going to "get them out" of their situation most of the time and they will not be appreciative when you do.

 

[jimjones]

How does psychiatry fit into the picture here in terms of criteria like what ann mentioned?

Uhhhh.... like I was using an example that applied to me personally that had nothing to do with Ann....But now that you mention it, how is it that psych does not qualify?

 

[jimjones]

Trust me, you are not going to "get them out" of their situation most of the time and they will not be appreciative when you do.

Are you a Psychiatrist? Who the uck are you?

 

[AnnK]

i do believe that psych fits my criteria very well. Altho, there aren't really any procedures, unless you count ECT, which isn't that much fun. It is a thought tho. I kind of liked my psych rotation. Im not sure if I am patient enough to be a psychiatrist. Something to think about anyway.

 

[Sonya]

one of the criterias "the more thinking, the better" How does psych fit into that.

okay, i'm an undergraduate senior still. just curiously and broadly looking at specialties now. I've had quite a bit of exposure to psych though.

I know very few psych patients ever fully recover.

 

[rad]

Sonya,

Do not worry so much about specialty selection now. I think it is very rare for a pre-clinical student to be sure about their future specialty. You will have a much better idea as you complete your third year of medical school and go thorugh all the clinical specialties. I was amazed and how many misconceptions I had about the specialties during my pre-clinical years. So it is good to investigate your options a little but things will eventually fall into place by themselves.


Also you will rarely have "intellectual stimulation" in any field in clinical medicine in my opinion. You will be like a very educated plumber in that you will see people with problems and will attempt to fix them. Except you have the option of fixing the mind, heart, lungs, skin etc. instead of pipes. I think intellectual stimulation can be found in medical research and clinical investigations. Good luck!

 

[jimjones]

OK, for my last post on this thread that has gone on and on....

First I'd like to appologise for being so short with people on this thread. I've been under a lot of pressure lately.

But I'd like to refer AnnK and others to this web page that you may have already seen. Its the Medcareers page that rates each specialty on a number of categories. some I think are intellectual content, innovative thinking, focus of expertise, etc.

<a href="http://www.aamc.org/about/progemph/medcareers/about/specorgs.html" target="_blank">http://www.aamc.org/about/progemph/medcareers/about/specorgs.html</a>

 

[jen628]

oy. it appears i posted to the wrong thread when i asked almost an identical question to ann's a couple weeks ago. except some of my preferences.

sooo, i have a specific question still if anyone is on call awaiting the beeper to go off like i am. (as i am currently on psych, i can add to the recent discussion by saying it is probably at the bottom of my list, and driving me nuts) anyway, i tangentially digress...

my question is, can a g surg also do primary care reproductive health?? is there ANY way to merge such opposite interests?

thanks

 

[Voxel]

Do OB/GYN. Surgery and primary care reproductive care.

 

[jen628]

i thought i should probably have posted again saying ps, i'd like not to have to do a bunch of tah/bsos or to deliver tons of babies. in other words, ob/gyn doesn't do it for me. :/

 

[Voxel]

You can do family practice and then practice in a rural area. You will be the "jack of all trades, master of none" physician. You will be able to do appendectomies and do reproductive health as well. If you have thoughts of practicing in an suburban/urban area, there will probably be general surgeons and Ob/Gyns in the area. This means it will be much harder for you do major operations, but not reproductive care.

 

[bzmd]

Dear friends,

I am still having a hard time choosing what specialty I like (e.g., patient care vs. non-patient care).
Originally, I was interested in Cardiology but now I have second thoughts about Rads, etc.
I thought that one way to definitely figure out what I want would be having done an IM residency first to see if I like patient care per se. Than I could go on with a Cards fellowship OR alternatively apply for Rads in case I decide that direct patient care specialties are not for me.

Is this an extravagant idea?

I would love to hear what you think.
Thank you.