Choosing your specialty

[Dr JPH]

Transitional year.

See if this helps, too http://www.studentdoctor.net/forums/showthread.php?s=&threadid=42023

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[Ronny]

Originally posted by Jamier2

Originally posted by Sandpaper:
•And oh, there's plenty of patient contact: they're just not aware of it, that's all. •••

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

They do complain. I knew an anesthesiologist that is retired now. He got sued at least once a month until he retired. But his hospital did pay his malpractice ins so he was set though.

 

[ApacheIndian]

Originally posted by 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.

Why do a whole 3-year IM residency? Why not just do a Prelim Med year? That oughta be enough for you to decide whether you wanna practice Med/Cards, or alternatively, if you wanna slide over to Rads (or any # of other fields). The Prelim med year would satisfy your PGY-1 requirement for all of these, and you'd leave your options wide open while not "wasting" extra years in a field that you might not end up practicing anyway. Good luck.

 

[munchi]

I am a fourth year medical student, have finished all my cores and have done a Sub-I in medicine and Surgery. I still can't figure out what I want to do.
I like surgery because it has difinitive problems and you can really intervene and fix that problem. It is very active. I like being in the OR and I think there is something to be said about having a manual skill as well as inteligence in becoming a physician.

On the other hand I think I fit in better with Medicine. I feel more comfortable with the people I work with and I like the variety in the cases seen. I also like the options medicine has to give in terms of further specialization. GI, Cardio and pukmonary all have some level of activity involved. Overall, though I do not like chronic care. I really need to see some benefit from my efforts, which I feel starved of in IM.

I literally go back and forth on this issue hour to hour. Any insight would help.

thanks a lot
munchi

 

[DrQuinn]

Go to Emergency Medicine... or Critical Care Medicine. Both give you an opportunity to use manual skills (lots o' procedures) with a LOT of medicine. You need to know a lot about a lot (like IM)... have a lot of patient interaction, a lot less paperwork/insurance stuff, etc.
Q

 

[Fah-Q]

I don't think there is much medicine in Emergency Medicine. EM docs seem to be just intermediaries. They handle all of the little problems that show up in the EC and if they think the patient needs to be admitted they simply call another doc (IM, surgery, etc.) to take the patient and then that doc does all the real work. Surgery runs all the trauma's, medicine is called for all MI's and GI bleeds, etc. What the heck do EM docs really do besides call someone else? So I would avoid EM like the plague. I used to be interested in it but after seeing what they actually do (or don't do) I have ruled it out completely.

 

[Renovar]

I agree with the above.

EM is basically a quick fix-up to buy time for medicine or surgery dudes to REALLY deal with the problem. They dont really do much else other than sewing people up quick, stop bleeding quick, stabilize the patient quick, and sending them off to the surgery or make a referral to medicine or other specialties. This is especially true if the ER doc is not within the large hospitals. There is a family friend of mine who is an ER doc at a local private hospital - he said all he does during the night is 1. seeing patients left-over from the PCP's (ie. afterhour headache/diahrea, but after their PCP's office hours), 2. writing admission orders for his trauma patients to a tertiary trauma center. Consider this a one-night stand - dont expect any lasting physician/patient relationships.

Generally speaking, from what I have heard from the MS4s in my school:

ER - for the aloof who is good thinking on the spot and working on the spot, but less adept at interpersonal skills.
IM - for the problem-solver type who likes to rationalize (ie. bullsh1t), enjoys talking (both to collegue and patients) and long-term physician/patient interactions.
Surgery - for the gung-ho no-bullsh1t type A's who likes to go in and deal with the problem head on.

 

[DrQuinn]

As for the comment on ER types being a little less adept at the interpersonal skills, I would have to disagree. Most EM physicians (and residents) are the MOST laid back easy going personable physicians, besides perhaps American pediatrician residents/physicians.

IM types are much more straight laced and cerebral, and tend to be less comfortable in a social setting.

Of COURSE, these are just generalizations and my opinion.

 

[DocWagner]

You gotta kinda laugh at all the responses regarding EM from you guys. Granted, each ED is different...but one thing is always a constant:
You never know what may enter the door, and even when you know they may be "SOB with CP"...it could be virtually anything and the EM docs primary responsibility is to rule out the EMERGENT life threatening problems first.
The first few minutes a patient walks through an emergency room door are always the most vital...not the stuff that happens on the floor. Regarding MI's, time is muscle baby...from the ED to cath lab is the important thing. I save em, stabilize em then the interventional cardiologist cath's em. Go for it.
The tricky part are weeding out the benign ones from the real ones.
It's fun
Plus, in what other field do you get to come to work in your pajamas and put a white coat over it and WHAMMO, you are ready for the day!

 

[Eyeluvu]

I suggest going into Ophthalmology!!! Woohoo!!! Combination of medicine and surgery. Neat and delicate surgeries at that! Have you ever scrubbed in on a retina case? Nothing is cooler!! Long term relationship with some patients. Others not so long term. Overall, very happy patients. Broad range of types of patients. You get to take care of what you need to do. You are the specialist. Unless of course, you need a subspecialist. But you could be that, too.
Relatively benign residency! You can start your life at residency. You don't need to put off enjoying things until you are done with your grueling gen surg residency. No offense, surg guys and gals. By the way, for most programs: home call! No more sleeping in strange beds, unless you're into that stuff, but that's another topic.
Since technically the retina and optic nerves are part of the central nervous system (as I see it, the brain is just an extension of the retina), you are really a neurosurgeon. HAHAHAH! Just kidding, I would never call myself that.
Anyway, life is good!! Consider ophthalmology. You will be hard pressed to find too many unhappy ophthalmologists, or ophthalmology residents for that matter.

 

[DrQuinn]

I think that there is just going to be more flaming of other specialties and vehemently defending the specialty that we choose to be in. Med vs. Surg, Surg vs. Med, Med vs. EM, etc... I think its innate that we believe the specialty we like best is the best for everyone. So, the originator of this topic, who wasn't sure what specialty was best for them... well, they're just hearing propaganda being slung across the WWW.
Q

 

[droliver]

I will reluctantly come to the defense of my ER colleagues here. I have been very impressed & had wonderful working relationships with a # of the residents I've worked with over my 5 years in residency. Though I often get frustrated with some of the CYA consults, I feel they do a very diffucult job pretty well most of the ime. Outside the University setting however, I feel some of the same frustrations that some people touched on earlier - you get the impression that they often just want to shift the work-ups for anything but the simplest patients to anyone they can get ahold of.

It sure sounds to me though that you'd happier doing one of the surgical specialties. Urology might be something to consider

 

[kenfused]

I think ER sounds pretty good for you!
A mix of "being able to fix people" quickly, as well as lots of good pathology, and plain old acute exacerbations of internal medicine issues: CHF, DM, MI, etc... and it's got a great practical use too: broken bones, cuts, and the like!

(no I'm not in ER)

 

[sanfilippo]

nearing the end of my medicine rotation, i, too, am unsure where my fate lies. if people can give me recommendations like ann got, that would be cool.

things i've learned about my interests while doing internal medicine;

--too much discussion and rounding
--too broad for my liking...like ann, want to be a consultant/'expert'
--like psychosocial aspects, listening to patients, answering questions unless pts come in as train-wrecks/non-compliance/etc
--like doing a good physical exam, more hands-on experience
--like thinking but want to be 'doing' as well
--something with a slightly faster pace
--not content with excessive ambiguity...like to explore/investigate, but want more definitive answers or clues
--don't mind long hours as long as i'm busy doing something rather than gabbing or waiting for labs
--work better with female pts than male
--can't handle addiction issues/substance abuse well if other pathology predominates
--age of pts is of no importance
--continuity of care not a priority for me--nice but not necessary
--clinic offers a nice break to inpatient...can't see myself as purely a 'hospitalist'

thanks
-s.

 

[agent]

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

i ahve that kind of relationship with my GI doctor, but i agree with all of the above

 

[pimmar]

Sanfillippo,

Seem like ob-gyn is right up your alley. Female patients, patients who you can discuss psychosocial issues, there is not much rounding on patients, you get to do a lot of hands on, you have office hours, its pretty fast paced, you will work long hours because you'll be busy, you'll see patients of all ages reproductive, menopausal, and post menopausal, and there is long-term care, in some cases there are women who will see their ob-gyn for almost all their health needs even not ob-gyn related, and its very rewarding. And in terms of lifestyle, there are a lot of ob-gyns in group practice which will give you more flexiblilty. Good Luck!

 

[Su4n2]

AnnK,
i see from other posts that u are going for rad onc. congrats w/making a decision. what attracted u to this specialty?

 

[AnnK73]

Rad Onc really does match my criteria pretty well that I posted in december, doesn't it?
But beyond that, i think that I really picked it becuase I like oncology. Something about the people, and my interest in the disease itself. Heme/onc was still an option and I rotated throught that too. Ultimately, I like being able to focus on oncology in rad onc more than heme/onc (both in residency and afterwords) and i like the technology (altho im not a big physics person) and lifestyle is a factor too.

Ill have to make this a little smoother for interviews (if I ever get any!)

Ann