Cold Feet or Change of Heart?

[mehc012]

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So, I've been fairly set on surgery since before I knew I wanted to go to medical school. Simply put, I love being in the OR. Once I decided to go to medical school, I found every opportunity that existed to get into the OR...I'd stay hours after my scribing shift to follow surgical patients we'd seen, I volunteered in the surgical waiting room of a children's hospital, I did a program that allowed premedical students to shadow extensively in the OR, etc.

When I got to med school, I was leery of boxing myself in too much, so I tried both to branch out, but also to shadow surgery enough to see if it became 'boring' to me eventually. What I generally heard was a) if you could picture yourself being happy anywhere but in the OR, don't do surgery, and b) Once the novelty wears off, the OR becomes less exciting. So with that in mind, I did a lot of shadowing in M1/M2. I tried to do a balance of both surgical and nonsurgical shadowing, but ended up highly skewed towards surgery because, well...spending 12hrs in and out of the OR on my off day felt invigorating, but I could barely keep my eyes open after hour 3 following an inpatient cardiologist. I spent a lot of time on Peds surg in particular, because I love kids, I respect the skill set that our peds surgeons have, and the personalities were a lot chiller. However, I found other good Gen Surg mentors as well.

When M3 came around, I again tried to keep an open mind. It turns out, I love rounding. I really like taking the time to discuss each patient in detail and argue about the best course of action. Inpatient IM was enjoyable. Outpatient and FM was, well...painful. I thought that perhaps I might find myself comfortable in a field like EM, rather than surgery after all. Then I did my surgery rotation and...holy crap, I forgot how much I loved the OR. I never left if there was still a case going, because it didn't even occur to me. I was literally never bored in the OR, even if I had no role. I was always engaged, asked questions, participated, anticipated. I love suturing, I love the little efficiencies and engineering feats in some of the surgeries. I love the OR atmosphere, the culture. I deal well with the surgical bluntness. I feel capable and competent when I'm in the OR, and even after 5yrs of shadowing frequently and participating little, I'm still not 'over it'. If anything, I love it more. So, surgery seemed like a done decision. I finished M3, with only 1 rotation left (peds), ruled out the other specialties, and set up all of my GS AIs.

Then I did Peds. And so far, I love it. I love the patients, I love the pathology...hell, I even enjoyed outpatient practice, which was a first for me. I love the culture, I love the rounding, I love their refusal to get labs just because they can, and instead doing only what they can concretely justify. I love the parent interactions, the explanations, the constantly changing ages, etc. Peds rounds are wonderful. And, of course, I love the schedule.

But there's no OR.

So now, I'm not sure what to think. Should I pull the trigger, switch to Peds, throw away all of the work I did in finally figuring out my M4 schedule with a mind towards surgery? Is this just cold feet and culture shock, or could I really be happy here? Maybe I should consider PICU, or something similar, as my long term. Can I live without the OR?

I learned a few things very clearly thoughout M3:
1. I hate being on a consult service. I prefer to own my patient.
2. I like rounding, and find surgical rounds disappointing
3. I love complex disorders with acute presentations...the slow, chronic ones don't tend to hold my interest as well
4. I still hate Neuro, and I'm too sympathetic to do Psych (too many depressed patients makes me depressed, too many manic/psychotic ones makes me on edge).
5. I deal well with high energy, high stress situations and fast pacing
6. I really enjoy procedures
7. I love working with kids, and I even like parents. I don't even mind the social considerations (I think largely because we have decided, as a society, that we will actually do something about them, even if we often fall short).
8. I dislike research, so I'm not sure Peds Surg is worth it in the long run
9. I do better in my real life the busier my work life is. I need long hours and set goals.

Thoughts? Would I be crazy to go ahead and do Gen Surg? Am I getting sucked in by the good teaching environment and leaning towards a career I'd ultimately dislike? Or am I letting the anxiety of having to restart with planning my M4 stop me from changing gears the way I ought?

My boards are excellent, I have straight Honors in M3 thus far (with 1 grade still pending and the Peds rotation not yet over). Minimal research. Demonstrated interest in global health and minority medicine. Good comments on my clerkship evals, including "works at the level of an intern" for surgery.

Things that are on my radar at the moment:
Peds Surg: The original pipe dream
Pro: surgery AND kids! High attention to detail and perfection of technique. Better atmosphere than most surgery. Interesting pathologies. Prestige.
Con: required to play the research game forEVER to get the clinical practice I want, with no better pay. Also lots of more minor procedures. Also still cruddy surgical rounds. Hyperspecialized.
Trauma Surg: What I decided I would enjoy if I couldn't stick the game long enough for Peds Surg
Pros: The fun parts of EM, plus the OR, plus you get to handle the SICU/TICU at many places = best of all worlds! You own all of your patients, though you do juggle a lot of outside consults. Shift work. Variable schedule (I like this. Yes, I know I'm crazy).
Cons: Long hours, large patient list, all with too many consults, EM docs run most of your traumas for you at a lot of places. Also, lots of tragic events.
Peds: The new kid on the block
Pros: As in the post. Short residency. Perhaps I'd be a good fit for PICU/NICU.
Cons: No OR. Mayyybe there'd be sufficient procedures in the PICU? Lots of outpatient.

 

[cubsrule4e]

How long have you been on peds so far? Have you been in the OR since you started peds? If not, have you found yourself wishing you were there instead?

 

[neworleans8]

What about PICU. Just a thought

Edit: never mind, saw you were already thinking about it

 

[mrbreakfast]

You've clearly thought about this a lot, so not much to say. But here are some attempts:

1) As you mentioned in the beginning, we were all repeatedly told to only do GS if we didn't like anything else. You need to decide for yourself if the OR is important enough to you that you'd regret not going into surgery. That's it.
2) You can do a lot of interesting surgery cases + complex rounds as a critical care surgeon. I don't think you can get away from the bread/butter GS stuff, though.
3) The "peds short residency" is kind of erased by the 3 year fellowships.
4) From the peds side, look into PICU/NICU. I had a NICU rotation and it seems to check a lot of your boxes: complex rounds, high-intensity patients, interventions, sub-specialist in your own world (no one else knows anything about tiny babies), shift work, you "fix" the patient and are done, etc. You technically get to go into stat Cs, though you just wait to grab the baby and run. At least in that hospital, the NICU/PICU docs also covered the peds EM consults/traumas.

It's March, you got time. Try to get in a high-acuity peds rotation and another surgery rotation each, get two sets of letters, and make the call before ERAS deadline. I know a number of people who dual-applied GS and another non-surgical field, but all of them ended up deciding on the non-surgical specialty.

 

[libertyyne]

PICU, Peds GI,

 

[deleted610572]

I still think you should Stick with surgery. It sounds like you are attracted to a great educational experience and the more relaxed feeling of peds. Yet your passion for surgery comes through in your post. I couldn’t get through a single surgery without staring at the clock. If you were able to shadow for years on end and not get bored then that’s saying something.

 

[mehc012]

You've clearly thought about this a lot, so not much to say. But here are some attempts:

1) As you mentioned in the beginning, we were all repeatedly told to only do GS if we didn't like anything else. You need to decide for yourself if the OR is important enough to you that you'd regret not going into surgery. That's it.

But it'd be so much easier if someone could just tell me which I should do!! (mostly kidding).

2) You can do a lot of interesting surgery cases + complex rounds as a critical care surgeon. I don't think you can get away from the bread/butter GS stuff, though.

I actually edited my post, because I realized that I like the bread and butter GS cases. Some of the bread and butter Peds Surg ones are less interesting, though.

3) The "peds short residency" is kind of erased by the 3 year fellowships.

3yrs Peds + 3yrs fellowship is still better than 5yrs GS + possible research years + fellowship. The Peds Surg path would certainly be longer (probably 10yrs) and trauma surgery would likely be equivalent, but longer hours.

4) From the peds side, look into PICU/NICU. I had a NICU rotation and it seems to check a lot of your boxes: complex rounds, high-intensity patients, interventions, sub-specialist in your own world (no one else knows anything about tiny babies), shift work, you "fix" the patient and are done, etc. You technically get to go into stat Cs, though you just wait to grab the baby and run. At least in that hospital, the NICU/PICU docs also covered the peds EM consults/traumas.

Oooh, if they do the traumas, that might be a game changer.

It's March, you got time. Try to get in a high-acuity peds rotation and another surgery rotation each, get two sets of letters, and make the call before ERAS deadline. I know a number of people who dual-applied GS and another non-surgical field, but all of them ended up deciding on the non-surgical specialty.

I've got 2mos of surgery AIs lined up starting in April, then planned for 2mo research and a third surgery AI afterwards, so...not much time for Peds, but if I decide to change, I have time to switch things around.

I was thinking of finishing Peds this month, then doing my next 2mo of surgery AIs and seeing how I feel after that. But leaving it off much past that is terrifying to me.

 

[libertyyne]

Have you thought about ENT at all?

Fellowship optional,
Surgery time.
Longitudinal patients
Can have a mix of patients skewed towards peds .

 

[AsianPersuasion]

You like Trauma? Come to Vascular 🙂

Real talk though, you should check out PICU.

 

[Gurby]

You like Trauma? Come to Vascular 🙂

PGY- Bad B**ch

Bruhhhhhhhhhh did you match a 0+5 program??? Been following your posts for the past few years!

 

[mehc012]

You like Trauma? Come to Vascular 🙂

Real talk though, you should check out PICU.

Haha, I actually did a month of Vascular during my surgery rotation in M3. I liked a lot of it, but I'm not a huge fan of the endovascular stuff, tbh, which takes away some of the fun.

Have you thought about ENT at all?

Fellowship optional,
Surgery time.
Longitudinal patients
Can have a mix of patients skewed towards peds .

I did consider ENT, but I haven't found a way to get good exposure to it, and at this point, with my lack of research, I feel as if it'd be a hard switch to make. I do like neck anatomy, not so sure about the E and N parts, lol.

 

[OrthoTraumaMD]

The original question stands: can you live without being in the operating room? Imagine yourself five, 10 years from now. Will you see people heading to whatever floor the OR is on, and wish you would be there too?

 

[mehc012]

How long have you been on peds so far? Have you been in the OR since you started peds? If not, have you found yourself wishing you were there instead?

2wks outpatient, 1wk newborn, and 1wk (of 3 total) inpatient peds.
No OR since I've started, but I felt as if the newborn resuscitations filled some of that gap for me. I had also just come out of my Gyn rotation, though, where I actually got to be the most involved in the OR that I've ever been able to in 3rd year (since the vaginal field in a hysterectomy isn't technically full sterile, they gave me more rein to do those components, so I'd remove the uterus, inflate the balloon, pass the suture up through the colpotomy, etc., while they all waited for me to handle my end.)
I came out of that rotation feeling really good about the OR, but otherwise I haven't been in a GS OR since December.

 

[mehc012]

The original question stands: can you live without being in the operating room? Imagine yourself five, 10 years from now. Will you see people heading to whatever floor the OR is on, and wish you would be there too?

I think this is the hard part. I feel as if I'm a constantly changing person...I put a lot of effort into personal growth, and I actually see results. Who I was 5yrs ago at 23 is a completely alien person to who I am now. I feel myself in the midst of another big shift right now, but...I don't know the impact that will have on my interests. I have a very difficult time imagining myself in 5-10yrs, so I really don't know the answer to this. I know, I know...if I don't know, nobody else will, either. But there's the rub.

 

[enalli]

Have you thought about ENT at all?

Fellowship optional,
Surgery time.
Longitudinal patients
Can have a mix of patients skewed towards peds .

OP, seriously consider this. Not just ENT, but most of the surgical subspecialties. You can be a surgeon for kids without being a pediatric surgeon.

 

[cubsrule4e]

2wks outpatient, 1wk newborn, and 1wk (of 3 total) inpatient peds.
No OR since I've started, but I felt as if the newborn resuscitations filled some of that gap for me. I had also just come out of my Gyn rotation, though, where I actually got to be the most involved in the OR that I've ever been able to in 3rd year (since the vaginal field in a hysterectomy isn't technically full sterile, they gave me more rein to do those components, so I'd remove the uterus, inflate the balloon, pass the suture up through the colpotomy, etc.)
I came out of that rotation feeling really good about the OR, but otherwise I haven't been in a GS OR since December.

Well regardless of what service you're on while in the OR, the crux of the matter is OR vs not OR. You're either a surgeon at heart or youre not. For me, I didnt care for GS at all, but felt like I would be totally unfulfilled if I didnt end up doing some kind of operating. I finally settled into ophtho and never looked back. Just continue on your peds rotation and listen for that voice in the back of your head. In 2 weeks if youre standing there rounding wondering when the next time you get to see the inside of an OR is, then you have your answer. Youve still got time to figure out peds surgery vs trauma surgery vs whatever surgery. If this rotation goes on and you find that the rounding and current work is so fascinating that you havent missed the OR at all, then that will obviously move you in the other direction. If its simply procedures you enjoy and not necessarily the OR itself, again thats something that can be done with peds as others have pointed out above.

 

[mehc012]

OP, seriously consider this. Not just ENT, but most of the surgical subspecialties. You can be a surgeon for kids without being a pediatric surgeon.

I have seriously considered most of the surgical subspecialties, and have shadowed not only adult but also pediatric cases in most of the fields.
Of the surgical subspecialties, the only one I would seriously consider would be ENT. I've only really written it off because I don't think I'm competitive for it without research or other demonstration of interest over the past 3yrs.

Plastics - incredibly interesting, I love the intellectual approach of reconstructive plastics, etc, and this was the other one I considered highly. I can't do the personalities, though.
Neurosurgery - I'm honestly just not interested enough in neuroanatomy or neurologic deficits for this
CT - I would only be happy in Peds CT, not in adult, and the career options for that aren't as flexible...nevermind that I would have to do a residency I disliked in order to only hopefully get a shot at a fellowship with long odds for eventual success.
Vascular - no kids, really, and I'm not a huge fan of the endovascular stuff.
Ortho - like CT, I love the anatomy, but not a fan of the operations.
Ophtho - No.
Uro - Too limited to one area.
Am I missing any other major ones?

I legitimately like general surgery, not as a path to another form of surgery, but because I like the abdomen. I like the diversity of organs visited. I like not being a consultant. I like that trauma, and pus, and liver, and endocrine, and GI, and pancreas, and more all fall into that realm.
I dislike (but can tolerate easily) the hours and the attitudes.
I would miss in depth rounding and not working closely with kids. Even peds surgeons don't work with kids the way pediatricians do, not even inpatient.

 

[mehc012]

Well regardless of what service you're on while in the OR, the crux of the matter is OR vs not OR. You're either a surgeon at heart or youre not. For me, I didnt care for GS at all, but felt like I would be totally unfulfilled if I didnt end up doing some kind of operating. I finally settled into ophtho and never looked back. Just continue on your peds rotation and listen for that voice in the back of your head. In 2 weeks if youre standing there rounding wondering when the next time you get to see the inside of an OR is, then you have your answer. Youve still got time to figure out peds surgery vs trauma surgery vs whatever surgery. If this rotation goes on and you find that the rounding and current work is so fascinating that you havent missed the OR at all, then that will obviously move you in the other direction. If its simply procedures you enjoy and not necessarily the OR itself, again thats something that can be done with peds as others have pointed out above.

Sure. I only included more specific subspecialties to give people more of an idea of what I find most appealing in the specialties. "General surgery vs Pediatrics" is a very different thread than "I like procedures and kids and high-intensity situations, I've considered PICU vs GS vs Peds surg vs Trauma, each of which appeal to me for these reasons...anyone seeing a pattern that I'm missing here?"

 

[Quantal Reasoning]

What's holding you back? If I'm honest it sounds like prestige?

 

[mehc012]

What's holding you back?

From what?

 

[Quantal Reasoning]

From what?

From pursuing peds

 

[mehc012]

From pursuing peds

I'm not certain enough that it's the right choice for me to upend an entirely-planned out M4 schedule that is starting in 3wks which revolves around getting me into a solid GS program and includes multiple surgical research projects and 3 already-committed-to AIs (each of which is either with a research mentor of mine or a department chair by design) that I'd have to back out of, discarding a LoR that I already asked someone to write for me, and scrambling to find a good Peds AI when our best local option filled up back in February and was popular enough that there was a lottery for slots.

I recognize that I still have time to switch to Peds, and that with a 95th percentile Step 1 score and straight honors thus far in med school, my odds of matching well in Peds are reasonable even if I don't get my pick of AIs, but frankly I just got past the anxiety-inducing period of running around trying to plan M4, and I'd really not like to have to redo that and undo all of the hard effort I've already put in for GS planning, unless I decide 100% that I need to go Peds instead of GS.

I will have to make a decision at some point. I don't much fancy splitting my focus and doing a half-assed job of each application, only to have to work twice as hard on ERAS and then make the same decision about my priorities come time to submit my rank order list. This is a decision that needs to be made in the next month or so, and no decision essentially equals a decision to go into surgery at this point.

So, I guess, the succinct answer would be: momentum.
But I'd be curious to hear why your ninja-edit was your first thought (why it seems like prestige is my driving force here)?

 

[TheLesPaul]

I would seriously reconsider surgical subspecialties like ophtho, urology, ortho, etc. Many surgeries that are boring to watch are really fun to do, and you can operate on kids. It's also fun to be an expert on something no one else knows much about. Very few other specialties will know enough to second guess you.

Procedures are really not the same as surgery, and until you run your own OR for a day it's hard to get that perspective. ICU procedures are typically among the most boring things a surgeon would do, yet are appealing to non-surgeons as they are the most interesting things they can do.

The OR is amazing and invigorating, and if you feel that way in truth, then you'll be sorely disappointed by non surgical fields. The cath lab and the endoscopy suite probably come close.

 

[libertyyne]

I'm not certain enough that it's the right choice for me to upend an entirely-planned out M4 schedule that is starting in 3wks which revolves around getting me into a solid GS program and includes multiple surgical research projects and 3 already-committed-to AIs (each of which is either with a research mentor of mine or a department chair by design) that I'd have to back out of, discarding a LoR that I already asked someone to write for me, and scrambling to find a good Peds AI when our best local option filled up back in February and was popular enough that there was a lottery for slots.

I recognize that I still have time to switch to Peds, and that with a 95th percentile Step 1 score and straight honors thus far in med school, my odds of matching well in Peds are reasonable even if I don't get my pick of AIs, but frankly I just got past the anxiety-inducing period of running around trying to plan M4, and I'd really not like to have to redo that and undo all of the hard effort I've already put in for GS planning, unless I decide 100% that I need to go Peds instead of GS.

I will have to make a decision at some point. I don't much fancy splitting my focus and doing a half-assed job of each application, only to have to work twice as hard on ERAS and then make the same decision about my priorities come time to submit my rank order list. This is a decision that needs to be made in the next month or so, and no decision essentially equals a decision to go into surgery at this point.

So, I guess, the succinct answer would be: momentum.
But I'd be curious to hear why your ninja-edit was your first thought (why it seems like prestige is my driving force here)?

Momentum is probably the last thing that should be deciding your career path. With your scores and grades/school rank most specialties are within reach if you put in some time for research and connections, talk to someone in the ENT department, or some other trusted person not in surgery. Also talk to a mentor in peds.

Another nuclear option is the GS residency comes with 5 years of funding so theoretically you could bail and still have time to complete Peds after a year or two. The other surgical subspecialty stuff is more urgent.

 

[Quantal Reasoning]

Scratch that, read all the posts,

Momentum is probably the last thing that should be deciding your career path. With your scores and grades/school rank most specialties are within reach if you put in some time for research and connections, talk to someone in the ENT department, or some other trusted person not in surgery. Also talk to a mentor in peds.

Another nuclear option is the GS residency comes with 5 years of funding so theoretically you could bail and still have time to complete Peds after a year or two. The other surgical subspecialty stuff is more urgent.

This is a much better way of saying what I wanted to say.

 

[enalli]

As I understand it, your next few months look like this:
April: Surgery Rotation
May: Surgery Rotation
June: Research
July: Research
August: Surgery Rotation

I would get rid of your research months and set up a peds Sub-I in June, and then, if possible, do some peds electives in July. You can make your decision by the end of July. This should cause minimal changes to your schedule.

You mentioned you don't have much research experience. At this stage of the game, two months at the start of your fourth year aren't going to produce any meaningful publications by the time interviews roll around and they also won't suddenly make PDs think you are a big researcher. If you're hesitant to let go of this research, then you can keep it for July, but I really think you may benefit from more peds exposure to make yourself sure of whichever choice you come to.

 

[mehc012]

I would seriously reconsider surgical subspecialties like ophtho, urology, ortho, etc. Many surgeries that are boring to watch are really fun to do, and you can operate on kids. It's also fun to be an expert on something no one else knows much about. Very few other specialties will know enough to second guess you.

Procedures are really not the same as surgery, and until you run your own OR for a day it's hard to get that perspective. ICU procedures are typically among the most boring things a surgeon would do, yet are appealing to non-surgeons as they are the most interesting things they can do.

The OR is amazing and invigorating, and if you feel that way in truth, then you'll be sorely disappointed by non surgical fields. The cath lab and the endoscopy suite probably come close.

I agree that procedures ≠ OR. In general, though I know that I prefer to be the jack of all trades rather than the super specialized person, and I also like procedures, though not as much as I like the OR. I don't like the patho, patient populations, or bread and butter operations of ortho, uro, or optho. Maybe I'd like them better if I were the one actually performing them, but I'd wager that's true with the other surgeries, too. I like GS because I like the abdomen, and because of the variety. I like Peds because they specialize in a patient population (and one with built-in variation!) and not just one organ system. Same for trauma. I considered ED for a while for similar reasons, but I dislike the lack of closure and the fact that you neither finish thinking about the patient NOR finish directly addressing their problem. It's a mishmash of the things I love about both medicine and IM, but without the must-haves of either.

Personally, I've never found that either catheterizations or endoscopy are even remotely similar to the OR. Sure, people are just as uptight about arbitrary sterile field rules (I've got no issues following them, as long as we all recognize on some level that maintaining a sterile field to drain a mountain of butt-pus is...unproductive, or that my scrubs are dirtier after rounds on 12 patients with skin infections, pneumonia, and C. diff than they would be if I took them home, put them on in the morning, and drove to work in them). If I couldn't be in the OR, I would prefer a procedure-heavy specialty to an endo or cath lab specialty.

 

[mehc012]

As I understand it, your next few months look like this:
April: Surgery Rotation
May: Surgery Rotation
June: Research
July: Research
August: Surgery Rotation

I would get rid of your research months and set up a peds Sub-I in June, and then, if possible, do some peds electives in July. You can make your decision by the end of July. This should cause minimal changes to your schedule.

You mentioned you don't have much research experience. At this stage of the game, two months at the start of your fourth year aren't going to produce any meaningful publications by the time interviews roll around and they also won't suddenly make PDs think you are a big researcher. If you're hesitant to let go of this research, then you can keep it for July, but I really think you may benefit from more peds exposure to make yourself sure of whichever choice you come to.

I had a lot of research experience in undergrad. I was involved in some research during M1/M2, but the projects fizzled out and I don't have much to point to from them. I've got a case report on the line, and actually a very interesting trauma surgery project that should be in strong swing by June if I put the time in.

My main goal with the research months is a) take Step 2 (both parts) and b) become involved enough in research that it's not a complete black hole in my app. I never expect it to be a strength, but I want to do enough that I can legitmately say "I am working on x project" and be able to speak intelligently about it, rather than just give a blank stare and have nothing to say about research. My application is strong enough that I am likely a candidate for top programs if I can get it to where the research gap is a soft spot, rather than a blatant, attention-grabbing deficiency.

Also, a research thesis is required by my school and was supposed to be completed in M3, I just pushed it back to get early AIs out of the way. They may let me push it back further, though, in which case swapping Peds in might be a good idea, thanks!

 

[mehc012]

Also, I'd like to thank everyone in this thread for taking this seriously and really offering me good advice and perspectives. This is something that I've thought a lot about, and which is really easier to see when I'm able to talk out my reasoning. All of you are making excellent points and suggestions, and if it seems like I'm pushing back on what you're saying, well...I'm truly trying to consider what you're saying and then see what my gut reaction is to it. If I feel resistant to being pushed in one direction vs the other, that's exactly the sort of thing I'm trying to find out about myself, as I think it says a lot about what I want to do but haven't quite figured out yet.

Thanks again...this sort of myriad perspective and conversation from people at all stages of training in all sorts of specialties is one of the strengths of SDN, and I really am grateful!

 

[enalli]

I had a lot of research experience in undergrad. I was involved in some research during M1/M2, but the projects fizzled out and I don't have much to point to from them. I've got a case report on the line, and actually a very interesting trauma surgery project that should be in strong swing by June if I put the time in.

My main goal with the research months is a) take Step 2 (both parts) and b) become involved enough in research that it's not a complete black hole in my app. I never expect it to be a strength, but I want to do enough that I can legitmately say "I am working on x project" and be able to speak intelligently about it, rather than just give a blank stare and have nothing to say about research. My application is strong enough that I am likely a candidate for top programs if I can get it to where the research gap is a soft spot, rather than a blatant, attention-grabbing deficiency.

Also, a research thesis is required by my school and was supposed to be completed in M3, I just pushed it back to get early AIs out of the way. They may let me push it back further, though, in which case swapping Peds in might be a good idea, thanks!

Alright, here's another idea: do you absolutely need that August surgery rotation? It sounds like you have a lot of surgical exposure and some strong letters coming your way. If you get rid of this rotation, you could squeeze Peds in June and still do two months of research in July and August.

 

[mehc012]

Momentum is probably the last thing that should be deciding your career path. With your scores and grades/school rank most specialties are within reach if you put in some time for research and connections, talk to someone in the ENT department, or some other trusted person not in surgery. Also talk to a mentor in peds.

Another nuclear option is the GS residency comes with 5 years of funding so theoretically you could bail and still have time to complete Peds after a year or two. The other surgical subspecialty stuff is more urgent.

Excellent point, and basically the exact error that I'm trying to prevent myself from making here. The easy path would be to go into surgery. If I don't make an active change, that is what will happen. This is my attempt at taking a step back and really evaluating whether I still want to go into surgery more than anything else, or whether I'm just doing it because it's already set up.

And don't think I haven't thought through the second part, lol...I figure GS→Peds is doable if I truly mess up my plans, but the reverse not so much, so that's actually another point towards sticking with GS.

 

[mehc012]

Alright, here's another idea: do you absolutely need that August surgery rotation? It sounds like you have a lot of surgical exposure and some strong letters coming your way. If you get rid of this rotation, you could squeeze Peds in June and still do two months of research in July and August.

Hmm...fair, and if I end up going Peds, I don't really need the research at all, so I could shift gears. I'm really aiming for a top GS program largely in order to keep the Peds Surg option open to me, but that wouldn't be necessary in Peds, as I don't think any of the fellowships are as dicey as Peds Surg is for GS folks.

 

[sunshinefl]

I initially was going to vote Peds surgery, but as I kept reading I’m now team ENT.

It’s a good mix of clinic, procedure, surgery.

You can sub-specialize into Peds ENT or other subspecialties.

 

[TheLesPaul]

I initially was going to vote Peds surgery, but as I kept reading I’m now team ENT.

It’s a good mix of clinic, procedure, surgery.

You can sub-specialize into Peds ENT or other subspecialties.

Exactly. Ophtho, ENT, urology, and ortho are likely the only "complete" fields left....fields where you can see all comers from adults to kids, complicated to simple, with a diversity of surgeries.

If you are bored by them, you really have no idea what they (we) do!

 

[ACSurgeon]

Couple of thoughts
- you won’t ever know which field is better for you. Whichever one you pick will be the only one you experience in depth and you might always wonder about the other field.

- sounds like you won’t be a researcher, so maybe not an academic physician in the future. As such, you need to consider work life balance and money. It needs to be part of your thought process. Also, community general surgeons can have a great work life balance unless you want to make a million dollars a year.

- you don’t need 3 surgery AI’s. Two will be plenty. You can do peds for the third rotation.

- I enjoyed all my third year rotations. Try to separate enjoying peds from truly loving it and wishing you can do it for ever.

- you mentioned “all the work” that you’ve put into surgery thus far. It pales compared to the time you are about to put in during residency and fellowship and beyond. So, this should be a non-factor.

It sounds like you want to be a surgeon but it sounds like you want to have everything you enjoy in a career. Not possible. Usually you get most things and still miss somethings (or have to put up with painful things).

As a surgeon you will always be a consultant. Even if you admit anyone you operate on or might operate on, a big chunk of your practice will be seeing patients in consultation. I guess if you specialize as a surgeon most these consults can be in clinic and most of your inpatient work can be on your service, but you’ll alsways have to take some amount of call and that involves helping non-surgeons figure out if someone has a surgical problem.

Finally: surgery and critical care is a great mix to be able to own patients, do in-depth medicine and still be a surgeon.

 

[libertyyne]

Couple of thoughts
- you won’t ever know which field is better for you. Whichever one you pick will be the only one you experience in depth and you might always wonder about the other field.

- sounds like you won’t be a researcher, so maybe not an academic physician in the future. As such, you need to consider work life balance and money. It needs to be part of your thought process. Also, community general surgeons can have a great work life balance unless you want to make a million dollars a year.

- you don’t need 3 surgery AI’s. Two will be plenty. You can do peds for the third rotation.

- I enjoyed all my third year rotations. Try to separate enjoying peds from truly loving it and wishing you can do it for ever.

- you mentioned “all the work” that you’ve put into surgery thus far. It pales compared to the time you are about to put in during residency and fellowship and beyond. So, this should be a non-factor.

It sounds like you want to be a surgeon but it sounds like you want to have everything you enjoy in a career. Not possible. Usually you get most things and still miss somethings (or have to put up with painful things).

As a surgeon you will always be a consultant. Even if you admit anyone you operate on or might operate on, a big chunk of your practice will be seeing patients in consultation. I guess if you specialize as a surgeon most these consults can be in clinic and most of your inpatient work can be on your service, but you’ll alsways have to take some amount of call and that involves helping non-surgeons figure out if someone has a surgical problem.

Finally: surgery and critical care is a great mix to be able to own patients, do in-depth medicine and still be a surgeon.

This might be aside, but what are the other fields that have similar surgery and critical care coverage?
Neurosurgery , trauma are the only ones that come to mind.

 

[mehc012]

Couple of thoughts
- you won’t ever know which field is better for you. Whichever one you pick will be the only one you experience in depth and you might always wonder about the other field.

Fair point.

- sounds like you won’t be a researcher, so maybe not an academic physician in the future. As such, you need to consider work life balance and money. It needs to be part of your thought process. Also, community general surgeons can have a great work life balance unless you want to make a million dollars a year.

I like the academic environment and I love teaching. Research is less interesting to me. If I could find a teaching-oriented academic job, that'd be ideal, though I'm open to private practice.

- you don’t need 3 surgery AI’s. Two will be plenty. You can do peds for the third rotation.

The third one is from the 'prestigious' place around here with all of the big names. First one is at the site I did my M3 rotation at and where my research mentors are, so it's a good way to start M4 in familiar territory with some likely letter writers who can pull double duty. Second one is with a department chair at our school's primary affiliation. Third is at the big name academic center. Seemed like each one contributed something different, was my original thinking.

- I enjoyed all my third year rotations. Try to separate enjoying peds from truly loving it and wishing you can do it for ever.

I also enjoyed all of my third year rotations. Peds and Surgery are both a step above that, though I'm trying to figure out if the Peds aspect is largely the 'newness' of it.

- you mentioned “all the work” that you’ve put into surgery thus far. It pales compared to the time you are about to put in during residency and fellowship and beyond. So, this should be a non-factor.

Fair point, and why I started this thread instead of dismissing these doubts.

It sounds like you want to be a surgeon but it sounds like you want to have everything you enjoy in a career. Not possible. Usually you get most things and still miss somethings (or have to put up with painful things).


As a surgeon you will always be a consultant. Even if you admit anyone you operate on or might operate on, a big chunk of your practice will be seeing patients in consultation. I guess if you specialize as a surgeon most these consults can be in clinic and most of your inpatient work can be on your service, but you’ll alsways have to take some amount of call and that involves helping non-surgeons figure out if someone has a surgical problem.

Finally: surgery and critical care is a great mix to be able to own patients, do in-depth medicine and still be a surgeon.

Haha, you got me. I'm still looking for that 'perfect' fit!
To clarify, I don't mind so much taking call or helping to decide if someone has a problem. What I dislike is the kind of consult service where someone else admits the majority of 'your' patients, then asks you to see them throughout the entirety of their hospitalization to give recommendations on an ongoing problem, only you don't own the patient, you can't actually make the other team do what you recommend, and you can't address any of their other concerns, you're just looking at the tiny part related to you. I don't mind going to see the patients, it's having half of my list on rounds who aren't actually 'my' patients that I find annoying.

 

[mehc012]

Exactly. Ophtho, ENT, urology, and ortho are likely the only "complete" fields left....fields where you can see all comers from adults to kids, complicated to simple, with a diversity of surgeries.

If you are bored by them, you really have no idea what they (we) do!

I don't think that's fair...different people like different things.
I don't like eyes or incontinence, and I've actually spent a fair amount of time observing ortho and I don't find the bread and butter interesting. I'm not excited by basic orthopedic procedures...fracture and dislocation reductions vaguely gross me out, rather than being interesting. I'd rather end up covered in blood and pus and poop than listen to the sound of a bone settling into place. It's not that I think there's little of interest in the field, so much as that the interesting parts don't happen to appeal to me.
I mean, I can do a fracture reduction, and dealing with one every once in a while is a different issue, but if a variety of traumas were coming in, the ortho injuries interest me a lot less than the skin and soft tissue injuries or the abdominal or thoracic problems. I'd rather repair a lac than reduce a fracture.

ENT, as I mentioned, seems like a very likely possibility. Of course, I'd have to figure out how to delve into that in the limited time I have left...I have only a few observed operations from ENT, and no clinic experience with them. They don't seem to be the primary service on inpatient very often, though, which is less my ballgame.

I initially was going to vote Peds surgery, but as I kept reading I’m now team ENT.

It’s a good mix of clinic, procedure, surgery.

You can sub-specialize into Peds ENT or other subspecialties.

Interesting. I posed one question and ended up pointed in a completely different direction! I love it.

 

[Mad Jack]

So, I've been fairly set on surgery since before I knew I wanted to go to medical school. Simply put, I love being in the OR. Once I decided to go to medical school, I found every opportunity that existed to get into the OR...I'd stay hours after my scribing shift to follow surgical patients we'd seen, I volunteered in the surgical waiting room of a children's hospital, I did a program that allowed premedical students to shadow extensively in the OR, etc.

When I got to med school, I was leery of boxing myself in too much, so I tried both to branch out, but also to shadow surgery enough to see if it became 'boring' to me eventually. What I generally heard was a) if you could picture yourself being happy anywhere but in the OR, don't do surgery, and b) Once the novelty wears off, the OR becomes less exciting. So with that in mind, I did a lot of shadowing in M1/M2. I tried to do a balance of both surgical and nonsurgical shadowing, but ended up highly skewed towards surgery because, well...spending 12hrs in and out of the OR on my off day felt invigorating, but I could barely keep my eyes open after hour 3 following an inpatient cardiologist. I spent a lot of time on Peds surg in particular, because I love kids, I respect the skill set that our peds surgeons have, and the personalities were a lot chiller. However, I found other good Gen Surg mentors as well.

When M3 came around, I again tried to keep an open mind. It turns out, I love rounding. I really like taking the time to discuss each patient in detail and argue about the best course of action. Inpatient IM was enjoyable. Outpatient and FM was, well...painful. I thought that perhaps I might find myself comfortable in a field like EM, rather than surgery after all. Then I did my surgery rotation and...holy crap, I forgot how much I loved the OR. I never left if there was still a case going, because it didn't even occur to me. I was literally never bored in the OR, even if I had no role. I was always engaged, asked questions, participated, anticipated. I love suturing, I love the little efficiencies and engineering feats in some of the surgeries. I love the OR atmosphere, the culture. I deal well with the surgical bluntness. I feel capable and competent when I'm in the OR, and even after 5yrs of shadowing frequently and participating little, I'm still not 'over it'. If anything, I love it more. So, surgery seemed like a done decision. I finished M3, with only 1 rotation left (peds), ruled out the other specialties, and set up all of my GS AIs.

Then I did Peds. And so far, I love it. I love the patients, I love the pathology...hell, I even enjoyed outpatient practice, which was a first for me. I love the culture, I love the rounding, I love their refusal to get labs just because they can, and instead doing only what they can concretely justify. I love the parent interactions, the explanations, the constantly changing ages, etc. Peds rounds are wonderful. And, of course, I love the schedule.

But there's no OR.

So now, I'm not sure what to think. Should I pull the trigger, switch to Peds, throw away all of the work I did in finally figuring out my M4 schedule with a mind towards surgery? Is this just cold feet and culture shock, or could I really be happy here? Maybe I should consider PICU, or something similar, as my long term. Can I live without the OR?

I learned a few things very clearly thoughout M3:
1. I hate being on a consult service. I prefer to own my patient.
2. I like rounding, and find surgical rounds disappointing
3. I love complex disorders with acute presentations...the slow, chronic ones don't tend to hold my interest as well
4. I still hate Neuro, and I'm too sympathetic to do Psych (too many depressed patients makes me depressed, too many manic/psychotic ones makes me on edge).
5. I deal well with high energy, high stress situations and fast pacing
6. I really enjoy procedures
7. I love working with kids, and I even like parents. I don't even mind the social considerations (I think largely because we have decided, as a society, that we will actually do something about them, even if we often fall short).
8. I dislike research, so I'm not sure Peds Surg is worth it in the long run
9. I do better in my real life the busier my work life is. I need long hours and set goals.

Thoughts? Would I be crazy to go ahead and do Gen Surg? Am I getting sucked in by the good teaching environment and leaning towards a career I'd ultimately dislike? Or am I letting the anxiety of having to restart with planning my M4 stop me from changing gears the way I ought?

My boards are excellent, I have straight Honors in M3 thus far (with 1 grade still pending and the Peds rotation not yet over). Minimal research. Demonstrated interest in global health and minority medicine. Good comments on my clerkship evals, including "works at the level of an intern" for surgery.

Things that are on my radar at the moment:
Peds Surg: The original pipe dream
Pro: surgery AND kids! High attention to detail and perfection of technique. Better atmosphere than most surgery. Interesting pathologies. Prestige.
Con: required to play the research game forEVER to get the clinical practice I want, with no better pay. Also lots of more minor procedures. Also still cruddy surgical rounds. Hyperspecialized.
Trauma Surg: What I decided I would enjoy if I couldn't stick the game long enough for Peds Surg
Pros: The fun parts of EM, plus the OR, plus you get to handle the SICU/TICU at many places = best of all worlds! You own all of your patients, though you do juggle a lot of outside consults. Shift work. Variable schedule (I like this. Yes, I know I'm crazy).
Cons: Long hours, large patient list, all with too many consults, EM docs run most of your traumas for you at a lot of places. Also, lots of tragic events.
Peds: The new kid on the block
Pros: As in the post. Short residency. Perhaps I'd be a good fit for PICU/NICU.
Cons: No OR. Mayyybe there'd be sufficient procedures in the PICU? Lots of outpatient.

You sound like a good fit for peds critical care. You would likely find NICU disappointing, as the presentations aren't all that varied, it is 90%+ premies with that being their only major issue and all sequelae being largely predictable

 

[mehc012]

You sound like a good fit for peds critical care. You would likely find NICU disappointing, as the presentations aren't all that varied, it is 90%+ premies with that being their only major issue and all sequelae being largely predictable

Yeah, I've thought that about NICU specifically. All the same, and frankly a reasonable proportion of the 'successes' aren't necessarily uplifting, either.

 

[Mad Jack]

Yeah, I've thought that about NICU specifically. All the same, and frankly a reasonable proportion of the 'successes' aren't necessarily uplifting, either.

We had pretty solid NICU outcomes at my old medical center, probably 90% success rate of keeping 23 weekers alive without blindness or disabling cerebrovascular bleeds. Actually had a whole wall of pictures of the grown up kids that would visit

 

[mehc012]

We had pretty solid NICU outcomes at my old medical center, probably 90% success rate of keeping 23 weekers alive without blindness or disabling cerebrovascular bleeds. Actually had a whole wall of pictures of the grown up kids that would visit

Wow, that's awesome!

 

[DarkHorizon]

Ortho>>>peds ortho. They do a lot of life changing operations and you only deal with kids.

 

[watermelon master]

I think this is the hard part. I feel as if I'm a constantly changing person...I put a lot of effort into personal growth, and I actually see results. Who I was 5yrs ago at 23 is a completely alien person to who I am now. I feel myself in the midst of another big shift right now, but...I don't know the impact that will have on my interests. I have a very difficult time imagining myself in 5-10yrs, so I really don't know the answer to this. I know, I know...if I don't know, nobody else will, either. But there's the rub.

Just curious: what effort have you put into your personal growth and how have you changed? I feel like my personal growth in medical school has been, well, stunted ever since I've started because all I've done is study. Sure I've grown in knowledge, but as a person? Haven't really changed since the beginning. Granted - I am an MS2 about to enter dedicated. Definitely a good interview question and if you don't want to answer here you can PM me 🙂

 

[Goro]

So, I've been fairly set on surgery since before I knew I wanted to go to medical school. Simply put, I love being in the OR. Once I decided to go to medical school, I found every opportunity that existed to get into the OR...I'd stay hours after my scribing shift to follow surgical patients we'd seen, I volunteered in the surgical waiting room of a children's hospital, I did a program that allowed premedical students to shadow extensively in the OR, etc.

When I got to med school, I was leery of boxing myself in too much, so I tried both to branch out, but also to shadow surgery enough to see if it became 'boring' to me eventually. What I generally heard was a) if you could picture yourself being happy anywhere but in the OR, don't do surgery, and b) Once the novelty wears off, the OR becomes less exciting. So with that in mind, I did a lot of shadowing in M1/M2. I tried to do a balance of both surgical and nonsurgical shadowing, but ended up highly skewed towards surgery because, well...spending 12hrs in and out of the OR on my off day felt invigorating, but I could barely keep my eyes open after hour 3 following an inpatient cardiologist. I spent a lot of time on Peds surg in particular, because I love kids, I respect the skill set that our peds surgeons have, and the personalities were a lot chiller. However, I found other good Gen Surg mentors as well.

When M3 came around, I again tried to keep an open mind. It turns out, I love rounding. I really like taking the time to discuss each patient in detail and argue about the best course of action. Inpatient IM was enjoyable. Outpatient and FM was, well...painful. I thought that perhaps I might find myself comfortable in a field like EM, rather than surgery after all. Then I did my surgery rotation and...holy crap, I forgot how much I loved the OR. I never left if there was still a case going, because it didn't even occur to me. I was literally never bored in the OR, even if I had no role. I was always engaged, asked questions, participated, anticipated. I love suturing, I love the little efficiencies and engineering feats in some of the surgeries. I love the OR atmosphere, the culture. I deal well with the surgical bluntness. I feel capable and competent when I'm in the OR, and even after 5yrs of shadowing frequently and participating little, I'm still not 'over it'. If anything, I love it more. So, surgery seemed like a done decision. I finished M3, with only 1 rotation left (peds), ruled out the other specialties, and set up all of my GS AIs.

Then I did Peds. And so far, I love it. I love the patients, I love the pathology...hell, I even enjoyed outpatient practice, which was a first for me. I love the culture, I love the rounding, I love their refusal to get labs just because they can, and instead doing only what they can concretely justify. I love the parent interactions, the explanations, the constantly changing ages, etc. Peds rounds are wonderful. And, of course, I love the schedule.

But there's no OR.

So now, I'm not sure what to think. Should I pull the trigger, switch to Peds, throw away all of the work I did in finally figuring out my M4 schedule with a mind towards surgery? Is this just cold feet and culture shock, or could I really be happy here? Maybe I should consider PICU, or something similar, as my long term. Can I live without the OR?

I learned a few things very clearly thoughout M3:
1. I hate being on a consult service. I prefer to own my patient.
2. I like rounding, and find surgical rounds disappointing
3. I love complex disorders with acute presentations...the slow, chronic ones don't tend to hold my interest as well
4. I still hate Neuro, and I'm too sympathetic to do Psych (too many depressed patients makes me depressed, too many manic/psychotic ones makes me on edge).
5. I deal well with high energy, high stress situations and fast pacing
6. I really enjoy procedures
7. I love working with kids, and I even like parents. I don't even mind the social considerations (I think largely because we have decided, as a society, that we will actually do something about them, even if we often fall short).
8. I dislike research, so I'm not sure Peds Surg is worth it in the long run
9. I do better in my real life the busier my work life is. I need long hours and set goals.

Thoughts? Would I be crazy to go ahead and do Gen Surg? Am I getting sucked in by the good teaching environment and leaning towards a career I'd ultimately dislike? Or am I letting the anxiety of having to restart with planning my M4 stop me from changing gears the way I ought?

My boards are excellent, I have straight Honors in M3 thus far (with 1 grade still pending and the Peds rotation not yet over). Minimal research. Demonstrated interest in global health and minority medicine. Good comments on my clerkship evals, including "works at the level of an intern" for surgery.

Things that are on my radar at the moment:
Peds Surg: The original pipe dream
Pro: surgery AND kids! High attention to detail and perfection of technique. Better atmosphere than most surgery. Interesting pathologies. Prestige.
Con: required to play the research game forEVER to get the clinical practice I want, with no better pay. Also lots of more minor procedures. Also still cruddy surgical rounds. Hyperspecialized.
Trauma Surg: What I decided I would enjoy if I couldn't stick the game long enough for Peds Surg
Pros: The fun parts of EM, plus the OR, plus you get to handle the SICU/TICU at many places = best of all worlds! You own all of your patients, though you do juggle a lot of outside consults. Shift work. Variable schedule (I like this. Yes, I know I'm crazy).
Cons: Long hours, large patient list, all with too many consults, EM docs run most of your traumas for you at a lot of places. Also, lots of tragic events.
Peds: The new kid on the block
Pros: As in the post. Short residency. Perhaps I'd be a good fit for PICU/NICU.
Cons: No OR. Mayyybe there'd be sufficient procedures in the PICU? Lots of outpatient.

How about OB/GYN?
Urology?

 

[OrthoTraumaMD]

I'd rather end up covered in blood and pus and poop than listen to the sound of a bone settling into place.

Aaaaahhhhhh heathen

 

[mehc012]

How about OB/GYN?
Urology?

I really liked OB/Gyn's balance of medicine and OR, but the diversity of operations is lacking...and I canNOT deal with the passive-aggressive culture.

 

[mehc012]

Aaaaahhhhhh heathen

I know!! I can't go into a field where I'm a blasphemer!!

 

[curbsideconsult]

I really liked OB/Gyn's balance of medicine and OR, but the diversity of operations is lacking...and I canNOT deal with the passive-aggressive culture.

+1

I could have dealt with the lack of diversity in procedures and probably would have ended up doing just ob, but that would have meant dealing with the culture of ob/gyn for 4 years. Like gag me with a spoon.

 

[CherryRedDracul]

I really liked OB/Gyn's balance of medicine and OR, but the diversity of operations is lacking...and I canNOT deal with the passive-aggressive culture.

Ugh. I can't either. Definitely the most passive-aggressive specialty I was exposed to in medical school.