Competitive applicants and uncompetitive residencies

[sdnetrocks]

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As a mid-year third-year student, I've narrowed things down based on my likes and dislikes to Med-Peds and straight IM. While these are probably 2 of the best residency choices for me, I am troubled by the somewhat impolite fact that I can do better...

Essentially, I attend a top-10 medical school, did reasonably well on Step 1 (249), and have consistently high (though not always top) grades from the preclinical and clinical years.

Granted, I have no publications and do not expect to be AOA. However, even with this, I feel like my stats put me in the running for the moderately competitive residency (rads, gas, oto, ophthy, etc.). Of course, I am not interested in these fields.

The problem, as I see it, is that while my stats are "too good" for med-peds or IM "in general", they are probably NOT glowing enough to get THE BIGGEST NAMES (MGH, Hopkins, UCSF, etc.). Which places me in the subset of "perfectly decent but clearly not the best med-peds/IM residency"... Which is nowhere near as impressive as the generic rads/gas/oto/ophthy/etc. residency.

I'm probably rambling a bit, but hopefully my point is clear. I realize that going into a field that I am not interested in just because:

- it's more competitive
- it's more prestigious
- it's more lucrative
- it has a better lifestyle
- i can get into it and others cannot

is a recipe for disaster. And yet, 10 or 15 years down the line, as I work like a dog for my humble income while my peers are rolling in dough while working 4 days a week, what if I look back and realize I was an idealistic idiot?

 

[Mumpu]

Would you rather be a miserable idiot?

 

[tigershark]

You quite obviously have no idea wtf you are talking about. Perhaps you should talk to your dean and get a better grasp of reality.

 

[beary]

The problem, as I see it, is that while my stats are "too good" for med-peds or IM "in general", they are probably NOT glowing enough to get THE BIGGEST NAMES (MGH, Hopkins, UCSF, etc.). Which places me in the subset of "perfectly decent but clearly not the best med-peds/IM residency"... Which is nowhere near as impressive as the generic rads/gas/oto/ophthy/etc. residency.

Hello,

I would do what you want to do. I have almost exactly the same stats as you (actually exact the same Step 1 score) and am going into path, which is not super competitive, but I could not be happier with it because it is what I want to do. Don't worry about not getting into big names now. Apply to the biggest names and also some less competitive places, go on interviews, and then assemble your rank list. You may very well match at MGH, Hopkins, etc.

Good luck.

 

[footcramp]

i'm sure this is something that a lot of people think about. it all comes down to what your values are. if you're the type of person that gets self-esteem from doing prestigious things, going to a top10 school, etc, then i would say you should think hard about the possibility of regret down the road. i'm not saying it's a bad thing; i think a lot of people go into medicine for the prestige to begin with. in fact i think people who absolutely don't care about that stuff are very rare. sure there are people with 250s going into family practice, medicine, or peds, but i think it takes a special kind of person to not feel like they're "giving up" something by going this route.

it's a matter of what drives you. if you find medicine or med/peds fascinating and you can't get enough of it, then there's no reason to think you won't love it 10 years from now. in that sense it won't be about "giving up" something but more about being able to do what you're passionate about. but if it's just something that's tolerable then maybe you should aim for the more cush specialties, which offer better compensation and lifestyle control.

i think from reading your post you tend to be the type that cares about prestige, since you mention going into the top med/peds spots. i know people like to say "do what you love" but in your case i don't think it's that simple. regret sucks, and free time with money to spend is not a shabby consolation prize. let's face it, normal people don't LOVE just one medical specialty and hate everything else. miserable gets tossed around lightly but come on, it's medicine, not fighting in afghanistan.

 

[Smurfette]

As a mid-year third-year student, I've narrowed things down based on my likes and dislikes to Med-Peds and straight IM. While these are probably 2 of the best residency choices for me, I am troubled by the somewhat impolite fact that I can do better...

Essentially, I attend a top-10 medical school, did reasonably well on Step 1 (249), and have consistently high (though not always top) grades from the preclinical and clinical years.

Granted, I have no publications and do not expect to be AOA. However, even with this, I feel like my stats put me in the running for the moderately competitive residency (rads, gas, oto, ophthy, etc.). Of course, I am not interested in these fields.

The problem, as I see it, is that while my stats are "too good" for med-peds or IM "in general", they are probably NOT glowing enough to get THE BIGGEST NAMES (MGH, Hopkins, UCSF, etc.). Which places me in the subset of "perfectly decent but clearly not the best med-peds/IM residency"... Which is nowhere near as impressive as the generic rads/gas/oto/ophthy/etc. residency.

I'm probably rambling a bit, but hopefully my point is clear. I realize that going into a field that I am not interested in just because:

- it's more competitive
- it's more prestigious
- it's more lucrative
- it has a better lifestyle
- i can get into it and others cannot

is a recipe for disaster. And yet, 10 or 15 years down the line, as I work like a dog for my humble income while my peers are rolling in dough while working 4 days a week, what if I look back and realize I was an idealistic idiot?

So many things wrong with this post...but will try to be constructive.

Keep in mind that the so-called "prestigious" specialties you mention now may not be the prestigious specialties in 5-10 years. 10-15 years ago, rads and gas (which, incidentally, I would argue is not "very prestigious" now, but is moderately competitive yet falling in popularity from where it was a few years ago) were not competitive at all, and neuro was hot. Now neuro is not too popular, and rads is pretty competitive. My point is, if you do rads and in 10 years, rads becomes one of the least popular specialties, will you suddenly regret it? And who cares if you do your residency at MGH versus somewhere else...are you going to tell your patients where you did residency "Hi, I'm Dr. SDNetrocks, and I trained at Harvard". Let's keep things in perspective...99% of patients have NO IDEA where their doc was trained, and they have no way of knowing that UCSF IM was more prestigious than NYU IM when you were in residency. The general public is more impressed by a "surgeon" or "obstetrician" than a "radiologist" or an "eye doctor", despite which one may be easiest to match into. Who are you trying to impress?

Do what you want to do, dude.

 

[sdnetrocks]

You quite obviously have no idea wtf you are talking about. Perhaps you should talk to your dean and get a better grasp of reality.

Unfortunately, this topic is so sensitive that I cannot imagine who I could possibly discuss it with as candidly as I can here. I considered going to the class counselor, but complaining about a six-figure salary to someone who barely makes above $60k just seems in poor taste.

As far as the competitive fields, surgical fields are out of the question. Gas might be okay, except for the fact that I could not imagine taking orders from surgeons all my life. Rads is out because I really enjoy patient contact. Ophthy doesn't excite me at all.

This pretty much leaves rad onc, derm, and IM-cards. Rad onc doesn't particularly excite me. Derm doesn't seem too bad (I'm considering an early fourth-year elective in it), but with no AOA and no research and no demonstrably steady interest, it may be a stretch... Cards is very cool, except that it requires an IM residency, which given my first post will not be super top-notch, thus erasing most of the "choosing capital" that I now have.

My actual top 3 are peds-ER, adolescent med, and IM-cards. Out of these 3, adolescent med is not very lucrative at all, and any ideas I have about setting up a boutique adolescent medicine practice are probably pipe-dreams.

I think that part of my problem may be that I personally dread a sense of guilt for turning away from the core primary care fields, as well as a sense of inadequacy for not being able to handle anything outside my narrow field as a specialist. As far as I can tell, my top 3 avoid these predicaments.

😕

 

[tool]

This has got to be a joke.....I sure hope it is anyway. You act like general internist make $40k a year. If money/lifestyle is what you're after then go for it but don't act like other fields of medicine making less are not as important.

 

[Pir8DeacDoc]

two of the very best in my class are doing family... >250 Step I... Just shut up and do what makes you happy. Why do you give two ****z what other people think? I'm going into surgery and I can tell you for sure there are a ton of people in my class more qualified than me if they wanted to be. you gotta stop pleasing other people and please yourself (that sounds a little dirty... )

 

[footcramp]

ok not to be rude but your perspective seems to be off a bit. you say:

"Essentially, I attend a top-10 medical school, did reasonably well on Step 1 (249), and have consistently high (though not always top) grades from the preclinical and clinical years."

then you worry about getting into a good enough IM residency to do cardiology, just because you don't have publications? it's obvious you haven't talked to your career advisor yet. you don't have to ask your counselor something like "should i go into derm for money?" but you can ask how competitive you are for various fields and what you can reasonably expect in the quality of programs. use your brain

 

[robotsonic]

Basing your future happiness on prestige and impressing others is usually a bad idea. You have impressive stats, but there will always be someone who is better than you in some way. You will probably even encounter these people at those non-competitive IM residencies that you mentioned.

A peds resident once gave me pretty good advice about choosing residency programs: Go where you will be happy, and don't worry about impressing your classmates on Match Day.

 

[AngryTesticle]

Go where you will be happy, and don't worry about impressing your classmates on Match Day.

Amen! Seriously, when you're busting your tail during your PGY-1 year trying to get adjusted and learning many new things, those fond memories of Match Day are so gone. Residency is a difficult phase of one's life so go into something you will enjoy so that you won't go insane.

And if you land a spot at one of these "top", "prestigious" programs (which doesn't hold a whole lot of clout for residency anyway), you WILL be busting your ass for sure.

 

[APACHE3]

The OP is an idiot. What an arrogant SOB. IM/IM-PEDS not smart??? are you f------ crazy!! I suggest you read up on medicare/insurance law, because that the ONLY reason that Rads and gas are "hot" now. As soon as reimbursements get cut, see how fast those disciplines fill up in the future. Just do what makes you happy (which seems to be to make $$ first, treat people second) Man, I hope your my sub-I on the ICU rotation, then we'll see whom you think is smart! A--H--- 😀

 

[ericdopt]

The OP is an idiot. What an arrogant SOB. IM/IM-PEDS not smart??? are you f------ crazy!! I suggest you read up on medicare/insurance law, because that the ONLY reason that Rads and gas are "hot" now. As soon as reimbursements get cut, see how fast those disciplines fill up in the future. Just do what makes you happy (which seems to be to make $$ first, treat people second) Man, I hope your my sub-I on the ICU rotation, then we'll see whom you think is smart! A--H--- 😀

Damn! 👍
Now, I did NOT go to a "Top 10" program (DO, obviously from my name). I am going into Rads, but it is because I LOVE it. I personally don't think I've got what it takes to be "just" a general IM doc. Now, I would still go into Rads regardless of its hotness, and would never go into a specialty just because it's more or less prestigious than something else. I'm an intern, and NOT ONE of my patients has ever asked me why am I a DO or where I went to medical school.
Unfortunately, I feel the OP's attitude is extrememly pervasive among medical students.
Do what you love, and the money will follow.

 

[EctopicFetus]

Do what you love, and the money will follow.

To the OP.. obviously you annoyed some people with the way you stated your point. Thing is this, there are a ton of people in the competitive specialties because instead of doing what they wanted to they followed what you are preaching and looked for prestige over happiness. This is a sure sign of being miserable and likely not finishing your residency.

Be happy man.. life is too short.

 

[DropkickMurphy]

Just do what makes you happy (which seems to be to make $$ first, treat people second)

What's wrong with that? So long as you're doing what's right for your patients is there something manifestly wrong with being motivated by money?

 

[MM9]

I think everyone should cut the OP some slack. He is just asking a question about one of the most important professional decisions he'll ever make.

We all know the guy from first year who loved cardiology and then, before you knew what happened, he was AOA and just HAD to be a dermatologist. You think ALL the people like that really really LOVE derm, plastics, or uro? Sure, a lot of them do, but many of them don’t. To me the OP has the edge on everyone as he’s being honest with himself about these feelings, rather than convincing himself to go and be an ophthalmologist.

These feelings are real consequence of the current med school culture and completely understandable. How is someone supposed to feel about statements like, "I personally don't think I've got what it takes to "just" be a general IM doc"? You'd never hear someone say "I don't have what it takes to be "just" a radiologist." This passive aggressive specialty bashing is all to frequent; and we're all guilty. When someone says to us they're going into Ortho, we raise our eyebrows and smile; but when someone mentions Peds or IM, we break eye contact and say, "Good for you". I know this first hand as I've seen things both sides, first matching into a "less desirable" specialty and changing into a "competitive" one.

The advice above is good, but could be delivered in a much more understanding and collegial manner. Talk to an adviser or an attending. Think past match day and look forward to what you’ll be doing with your day once out of residency. Do what will make you excited to get out of bed in the morning.

 

[EctopicFetus]

Do what will make you excited to get out of bed in the morning.

Thats why I married her

Sorry but thats what came to my mind!

 

[Poety]

Thats why I married her

Sorry but thats what came to my mind!

Thats sweet EF 🙂

 

[DrNick2006]

My Advice to the original poster is that if you do well in your clinical years and get honors and good letters then getting into a top 10 IM program will be completely possible. I have a similar resume, but go to a less repected state school and I have interviews at very good programs. Sure I didn't get MGH or JHU or UCSF, but i bet a million bucks if I went to Harvard, Yale etc for med school I would have gotten those interviews in a heartbeat, so I'm sure you will be just fine.

 

[MM9]

Thats why I married her

Sorry but thats what came to my mind!

Excellent work.....I didn't know it was a straight line all along.

 

[tool]

Ummm I don't get your point between cards and derm. Cards makes more $$$ and I would argue that cards is viewed way more "prestigious".

 

[LADoc00]

As a mid-year third-year student, I've narrowed things down based on my likes and dislikes to Med-Peds and straight IM. While these are probably 2 of the best residency choices for me, I am troubled by the somewhat impolite fact that I can do better...

Essentially, I attend a top-10 medical school, did reasonably well on Step 1 (249), and have consistently high (though not always top) grades from the preclinical and clinical years.

Granted, I have no publications and do not expect to be AOA. However, even with this, I feel like my stats put me in the running for the moderately competitive residency (rads, gas, oto, ophthy, etc.). Of course, I am not interested in these fields.

The problem, as I see it, is that while my stats are "too good" for med-peds or IM "in general", they are probably NOT glowing enough to get THE BIGGEST NAMES (MGH, Hopkins, UCSF, etc.). Which places me in the subset of "perfectly decent but clearly not the best med-peds/IM residency"... Which is nowhere near as impressive as the generic rads/gas/oto/ophthy/etc. residency.

I'm probably rambling a bit, but hopefully my point is clear. I realize that going into a field that I am not interested in just because:

- it's more competitive
- it's more prestigious
- it's more lucrative
- it has a better lifestyle
- i can get into it and others cannot

is a recipe for disaster. And yet, 10 or 15 years down the line, as I work like a dog for my humble income while my peers are rolling in dough while working 4 days a week, what if I look back and realize I was an idealistic idiot?

Do gas, make a ton of $$$, buy a nice house, marry a 25 year old hottie sales rep, buy the Porsche and S-T-F-U.

 

[Empedocles]

So many things wrong with this post...but will try to be constructive.

Keep in mind that the so-called "prestigious" specialties you mention now may not be the prestigious specialties in 5-10 years. 10-15 years ago, rads and gas (which, incidentally, I would argue is not "very prestigious" now, but is moderately competitive yet falling in popularity from where it was a few years ago) were not competitive at all, and neuro was hot. Now neuro is not too popular, and rads is pretty competitive. My point is, if you do rads and in 10 years, rads becomes one of the least popular specialties, will you suddenly regret it? And who cares if you do your residency at MGH versus somewhere else...are you going to tell your patients where you did residency "Hi, I'm Dr. SDNetrocks, and I trained at Harvard". Let's keep things in perspective...99% of patients have NO IDEA where their doc was trained, and they have no way of knowing that UCSF IM was more prestigious than NYU IM when you were in residency. The general public is more impressed by a "surgeon" or "obstetrician" than a "radiologist" or an "eye doctor", despite which one may be easiest to match into. Who are you trying to impress?

Do what you want to do, dude.

Excellent answer!

 

[RonaldColeman]

i'm sure this is something that a lot of people think about. it all comes down to what your values are. if you're the type of person that gets self-esteem from doing prestigious things, going to a top10 school, etc, then i would say you should think hard about the possibility of regret down the road. i'm not saying it's a bad thing; i think a lot of people go into medicine for the prestige to begin with. in fact i think people who absolutely don't care about that stuff are very rare. sure there are people with 250s going into family practice, medicine, or peds, but i think it takes a special kind of person to not feel like they're "giving up" something by going this route.

it's a matter of what drives you. if you find medicine or med/peds fascinating and you can't get enough of it, then there's no reason to think you won't love it 10 years from now. in that sense it won't be about "giving up" something but more about being able to do what you're passionate about. but if it's just something that's tolerable then maybe you should aim for the more cush specialties, which offer better compensation and lifestyle control.

i think from reading your post you tend to be the type that cares about prestige, since you mention going into the top med/peds spots. i know people like to say "do what you love" but in your case i don't think it's that simple. regret sucks, and free time with money to spend is not a shabby consolation prize. let's face it, normal people don't LOVE just one medical specialty and hate everything else. miserable gets tossed around lightly but come on, it's medicine, not fighting in afghanistan.

ditto. Clearly, money and prestige are important to you. Whether this is noble or not is irrelevant. If this is part of what brings you happiness and fulfillment, it should be taken into consideration when applying for a residency.
In response to another poster: your patients may not ask you where you went to medical school, and the public might consider a cardiologist more prestigious than a dermatologist...but your peers know better. While it is certainly not always true, many of your peers will assume you chose internal medicine because you weren't strong enough to match into a more competitive specialty.

 

[Poety]

Do gas, make a ton of $$$, buy a nice house, marry a 25 year old hottie sales rep, buy the Porsche and S-T-F-U.

What is S T F U? 😳

 

[Hurricane]

While it is certainly not always true, many of your peers will assume you chose internal medicine because you weren't strong enough to match into a more competitive specialty.

Many? Hopefully it's more like "a few." Honestly, until I read this post, it would never have crossed my mind to assume that someone who went into IM did so because they weren't competitive. I just figure they went into it because they liked it, and thank goodness they do, because I hate IM, and somebody's got to do it.

And if there are people out there who assume I'm going into pscyh because it's less competitive rather than because it's what I like... well, those aren't the kind of people whose opinions I value anyway!

 

[Poety]

ditto. Clearly, money and prestige are important to you. Whether this is noble or not is irrelevant. If this is part of what brings you happiness and fulfillment, it should be taken into consideration when applying for a residency.
In response to another poster: your patients may not ask you where you went to medical school, and the public might consider a cardiologist more prestigious than a dermatologist...but your peers know better. While it is certainly not always true, many of your peers will assume you chose internal medicine because you weren't strong enough to match into a more competitive specialty.

To the bold I agree, and to the underlined - thats absurd. I'm yet to meet any attending that looks at his/her "IM" colleague and thinks "Oh he/she couldn't have gotten into a more competitive specialty" - ridiculous.

It'll be so interesting to see how half of your perspectives change once you're out WORKING in the real world for a while. And I'm not talking about residency - I'm talking about an attending rank here. 🙄

Wheres BKN when a thread needs him grrrr

 

[sdnetrocks]

While it is certainly not always true, many of your peers will assume you chose internal medicine because you weren't strong enough to match into a more competitive specialty.

It's the OP here again....

I actually agree with this statement very passionately. Perhaps this is one of the reasons I see that doing a specialty that is less competitive than I am potentially qualified for is a waste... Something akin to choosing to go to the decent state school for college rather than the ivy league (assuming tuition, etc. is the same), even though you know you could have gotten into the ivy league and many of your peers at the state school could not have.

On the issue of cards vs. derm salaries - while there may be some overlap there, I think that derm wins hands-down in terms of lifestyle (aka $/hr).

I really appreciate all of the responses to this thread, as well as the PMs. To all of the negative responses - no, I am not joking, and no, I did not post this thread to be a jerk or show-off or whatever. This is some very honest documentation of what's going on in my head as I head towards perhaps the biggest life decision I have ever made. And I sure would hate to not think this through fully.

The way our health system is set up, for better or for worse, is that some specialties are more competitive than others, some are more lucrative than others, some offer nicer lifestyles than others, etc. I have the opportunity that many others don't to get into specialties that are "better" on those scales. It seems somehow wrong to dismiss that advantage, which by the way I have worked very hard for, without a second thought.

Still trying to figure things out...

 

[RonaldColeman]

To the bold I agree, and to the underlined - thats absurd. I'm yet to meet any attending that looks at his/her "IM" colleague and thinks "Oh he/she couldn't have gotten into a more competitive specialty" - ridiculous.

It'll be so interesting to see how half of your perspectives change once you're out WORKING in the real world for a while. And I'm not talking about residency - I'm talking about an attending rank here. 🙄

Wheres BKN when a thread needs him grrrr

I certainly don't feel this way. Also, saying "many" was my way of indicating that I have encountered it quite frequently during my 3rd and 4th years. Perhaps my experience is an outlier--I can only speak about what I have seen.
To be clear, I don't think attendings are walking around thinking "Oh, that guy is stupid; he could only match into IM." At the same time, they aren't thinking "top of the class" like they do when they encounter someone in dermatology, ortho, etc. Unlike IM where you get a broad range of applicants, people KNOW you were at or near the top of the class if you match in derm. That's what makes it prestigious.

 

[f_w]

This is some very honest documentation of what's going on in my head as I head towards perhaps the biggest life decision I have ever made. And I sure would hate to not think this through fully.

For the things going on in your head, counseling might be a better fix than this BB. You seem to have some self image issues that someone in the psych forum might be better qualified to comment on. (The question of what image you can offer to your surroundings seems to be the driving force behind your decision making process, not so much a rational weiging of pros and cons of the various specialties.)

If you are oh so smart, you will make a great internist (heaven knows, we need some). And if your abilities extend beyond the skill of getting good scores on standardized exams, I have no doubt you will be able to get the subspecialty fellowship of your choice (cards/gi/heme-onc). Income potential in IM subspecialties is comparable to some of the 'competitive' fields that you are so preoccupied with, so don't worry, you will be able to put food on the table.

 

[RonaldColeman]

If you are oh so smart, you will make a great internist (heaven knows, we need some).

What exactly are you implying here?

 

[Poety]

I certainly don't feel this way. Also, saying "many" was my way of indicating that I have encountered it quite frequently during my 3rd and 4th years. Perhaps my experience is an outlier--I can only speak about what I have seen.
To be clear, I don't think attendings are walking around thinking "Oh, that guy is stupid; he could only match into IM." At the same time, they aren't thinking "top of the class" like they do when they encounter someone in dermatology, ortho, etc. Unlike IM where you get a broad range of applicants, people KNOW you were at or near the top of the class if you match in derm. That's what makes it prestigious.

Have you for one second considered the idea that maybe they aren't thinking about you or anyone else they're working with at all? Is that even a possibility? I mean come on - if you think when I encounter my colleague I'm going to think "Ohhh they're derm, how brilliant, or ohhhh they're optho what a brainiac" you're crazy.

I happen to know for a fact a few people in my class that got those specialties by OTHER MEANS i.e. they didn't do straight derm or rads since they didn't have the "scores' or whatever the heck those specialties look for the first time around. They did a year of research after to get their foot in the door - you are fooling yourself if you think there's only AOA's or 250 board scores in these specialties - and yes, you seriously need some life experience since your views are twisted into this whole medical school POV that is TOTALLY off base in the real world. 😱

And note: Residency is SO part of this skewed image - here again, I'm talking attending status as people that have worked and have a real idea on how they look upon their colleagues/peers. 🙄

BKN BKN!!! WHERE ARE YOU??

 

[EctopicFetus]

What is S T F U? 😳

It stands for Shut the F up..

Please dont ask me to tell you what the F stands for poety! 😉

 

[abcyxz]

forget trying to be constructive, i have 2 things to say to the OP:
1) get over yourself... really
2) you are not going to be the only smart cookie in ANY field

hopefully u can get a grasp on reality in the next few months or hopefully u get weeded out cuz you would be the last person i would ever want to work with

 

[TommyGunn04]

These feelings are real consequence of the current med school culture and completely understandable. How is someone supposed to feel about statements like, "I personally don't think I've got what it takes to "just" be a general IM doc"? You'd never hear someone say "I don't have what it takes to be "just" a radiologist." This passive aggressive specialty bashing is all to frequent; and we're all guilty.

I think you're right about the culture of medicine propagating these judgments about the prestige of certain fields. That said, I do in fact often say that I could never "just be a radiologist," because I realize that spending all that time in dark rooms with little patient contact would drive me nuts! That's one of the reasons why I chose IM. But every person is different, and self-discovery is a large part of this whole process. I'm not cut out for rads, but it's an important job and we all benefit from having talented people do it. That said, hopefully our career decisions will be based on what we think is best for us personally, and not based on what others think about the prestige of our field. This involves ascertaining relevant features of various specialties and attempting to match them up with our own personal preferences, in terms of, for example, our desire to do procedures, to manage complex problems, to specialize in a particularly interesting area or organ system, to pursue research, etc. I often worry about people who've seemingly decided on a particular field because of prestige and salary. Medicine is such a demanding profession that if these are your motivations you're perhaps more likely to end up really hating your job in a few years, and becoming very cynical and jaded.

As an aside to the original poster, if you're coming from a top-10 med school and have a 249 on step 1 then you're likely a competitive candidate at a top medicine program like Hopkins of MGH, unless you have really poor letters or something else strange about your application. I don't understand why you'd say that you're not good enough for a top residency spot in IM, given that background.

And remember, lucritive does NOT necessarily = happy, nor does "lifestyle"

 

[Poety]

It stands for Shut the F up..

Please dont ask me to tell you what the F stands for poety! 😉

pffft oh i get it - i like it 😱

Im kidding, I dont swear 😀

 

[EctopicFetus]

On the issue of cards vs. derm salaries - while there may be some overlap there, I think that derm wins hands-down in terms of lifestyle (aka $/hr).

I think your assumption is way way off base. In terms of $/hr you are off base. Now you def work more hours doing cards but $ per hour.. I dont think so..
from this site.. we will gather salary info.
http://www.alliedphysicians.com/salary-surveys/physicians/

We will use avg (>3 yrs) info.

Invasive Cards - $395K
Interventional - $468K
NonInvasive - $403K

Derm - 308K

For hours..
http://residency.wustl.edu/
Derm 42
There is no info on that site for Cards..We will assume working 48 weeks a yr (4 weeks off).

but Derm $/hr is $153/hr

For the above fields to have the same $ per hour they would have to work this many weeks

Invasive Cards - 53.8
Interventional - 63.8
NonInvasive - 55.0

So if you want some bang for your buck interventional is where it is at!

Hope this helps with making your decision!

 

[EctopicFetus]

pffft oh i get it - i like it 😱

Im kidding, I dont swear 😀

Poety I liked your other pic more FWIW..

 

[f_w]

If you are oh so smart, you will make a great internist (heaven knows, we need some).

What exactly are you implying here?

I am on call and just earlier had a conversation with a less than bright colleague in IM (n=1 provided a skewed picture).

 

[GoPistons]

yeah right... cards get waken up at all hours of the night... there is certainly no comparison between QOL btw cards and derm... derms hands down...

anyway, IM can be a catapult into something prestigious... currently GI and cards I suppose are the most prestigious... but I think any of the specialties in medicine heme/onc, cards, GI, allergy, etc. are prestigious to me... but what do I know... I'm going into Rads... Rads is "prestigious" now, but I highly doubt that it will be in the future... all specialties are set to be on the chopping block shortly... including cards and GI...

your concept of how much $$$ you will make is totally heresey... no one can predict how much a specialty will earn in the future... I guarantee they will all earn less than they do now... given the current federal deficit/aging population... now which ones will have the biggest declines... I don't know...

 

[sdnetrocks]

If you are oh so smart, you will make a great internist (heaven knows, we need some). And if your abilities extend beyond the skill of getting good scores on standardized exams...

I never claimed to be oh-so-smart, nor do I think I am at this point. (We were all oh-so-smart in high school and maybe college in order to get where we are now, but at this point, very few people can stay oh-so-smart at med school. And I am certainly NOT one of them). Whatever few nuggets of gold that comprise my application were earned with hard work (i.e. studying my a** off in undergrad while others partied to get to a good med school, studying my a** off for the step 1, busting my a** to impress on clinical rotations) rather than any sort of oh-so-smart native intelligence. And to waste all that hard work seems like, just that, a waste.

As an aside to the original poster, if you're coming from a top-10 med school and have a 249 on step 1 then you're likely a competitive candidate at a top medicine program like Hopkins of MGH, unless you have really poor letters or something else strange about your application. I don't understand why you'd say that you're not good enough for a top residency spot in IM, given that background.

No, my letters will be just as glowing as the next applicant's, and there is really nothing strange about my application. However, I feel like I don't have the extra "something" that I imagine a top IM program might like, such as building a clinic in Zimbabwe, having an ungodly Step 1, having a half-dozen publications or 1 real good one, having a PhD/JD/MBA/MPH/etc., or some combination of the above. I'm actually pretty vanilla in terms of those things.

 

[PickyBicky]

As a mid-year third-year student, I've narrowed things down based on my likes and dislikes to Med-Peds and straight IM. While these are probably 2 of the best residency choices for me, I am troubled by the somewhat impolite fact that I can do better...

Essentially, I attend a top-10 medical school, did reasonably well on Step 1 (249), and have consistently high (though not always top) grades from the preclinical and clinical years.

Granted, I have no publications and do not expect to be AOA. However, even with this, I feel like my stats put me in the running for the moderately competitive residency (rads, gas, oto, ophthy, etc.). Of course, I am not interested in these fields.

The problem, as I see it, is that while my stats are "too good" for med-peds or IM "in general", they are probably NOT glowing enough to get THE BIGGEST NAMES (MGH, Hopkins, UCSF, etc.). Which places me in the subset of "perfectly decent but clearly not the best med-peds/IM residency"... Which is nowhere near as impressive as the generic rads/gas/oto/ophthy/etc. residency.

I'm probably rambling a bit, but hopefully my point is clear. I realize that going into a field that I am not interested in just because:

- it's more competitive
- it's more prestigious
- it's more lucrative
- it has a better lifestyle
- i can get into it and others cannot

is a recipe for disaster. And yet, 10 or 15 years down the line, as I work like a dog for my humble income while my peers are rolling in dough while working 4 days a week, what if I look back and realize I was an idealistic idiot?

To be honest, what is your point? You want something "sexy," something people will go "oh wow!" when you tell them what you do? Something that "pays" really well. You like IM, but don't want to do it unless your at a big name place like MGH, Hopkins, or UCSF. Do the IM folks a favor and stay away if this is your attitude. Remember, "the skin is the window to disease." Ah ha ha ha ha ha ha ha!

-PB

 

[PickyBicky]

As a mid-year third-year student, I've narrowed things down based on my likes and dislikes to Med-Peds and straight IM. While these are probably 2 of the best residency choices for me, I am troubled by the somewhat impolite fact that I can do better...

Essentially, I attend a top-10 medical school, did reasonably well on Step 1 (249), and have consistently high (though not always top) grades from the preclinical and clinical years.

Granted, I have no publications and do not expect to be AOA. However, even with this, I feel like my stats put me in the running for the moderately competitive residency (rads, gas, oto, ophthy, etc.). Of course, I am not interested in these fields.

The problem, as I see it, is that while my stats are "too good" for med-peds or IM "in general", they are probably NOT glowing enough to get THE BIGGEST NAMES (MGH, Hopkins, UCSF, etc.). Which places me in the subset of "perfectly decent but clearly not the best med-peds/IM residency"... Which is nowhere near as impressive as the generic rads/gas/oto/ophthy/etc. residency.

I'm probably rambling a bit, but hopefully my point is clear. I realize that going into a field that I am not interested in just because:

- it's more competitive
- it's more prestigious
- it's more lucrative
- it has a better lifestyle
- i can get into it and others cannot

is a recipe for disaster. And yet, 10 or 15 years down the line, as I work like a dog for my humble income while my peers are rolling in dough while working 4 days a week, what if I look back and realize I was an idealistic idiot?

To be honest, what is your point? You want something "sexy," something people will go "oh wow!" when you tell them what you do? Something that "pays" really well. You like IM, but don't want to do it unless you're at a big name place like MGH, Hopkins, or UCSF. Do the IM folks a favor and stay away if this is your attitude. Remember, "the skin is the window to disease." Ah ha ha ha ha ha ha ha!

-PB

 

[RonaldColeman]

Have you for one second considered the idea that maybe they aren't thinking about you or anyone else they're working with at all? Is that even a possibility? I mean come on - if you think when I encounter my colleague I'm going to think "Ohhh they're derm, how brilliant, or ohhhh they're optho what a brainiac" you're crazy.
QUOTE]


Actually, I do think doctors think about this. We're type As, baby! Honestly, you're fooling yourself if you don't think there are a good number of docs in competitive specialties who look down (in a relative sense) on those in primary care. I never said it was right. I'm just saying that it exists, I've seen it many times, and that if you are concerned with prestige, it is something you should think about.

 

[Eyesore]

Go into ophthalmology and then be a vitreoretinal surgeon!! 👍 👍

 

[Poety]

Have you for one second considered the idea that maybe they aren't thinking about you or anyone else they're working with at all? Is that even a possibility? I mean come on - if you think when I encounter my colleague I'm going to think "Ohhh they're derm, how brilliant, or ohhhh they're optho what a brainiac" you're crazy.
QUOTE]


Actually, I do think doctors think about this. We're type As, baby! Honestly, you're fooling yourself if you don't think there are a good number of docs in competitive specialties who look down (in a relative sense) on those in primary care. I never said it was right. I'm just saying that it exists, I've seen it many times, and that if you are concerned with prestige, it is something you should think about.

Having worked the cardio wards, step down and icu when you were a wee one in diapers, I seriously doubt my image is skewed and I can tell you straight from the hip - docs that have TIME to look down on others are not the best doctors out there at all - they should be worrying about their patients. This coming from mr. affirmative action 😴

And I'd like some concrete "examples" of this "looking down" that you've seen - and again, I'm not talking residents here, I'm talking straight from an attendings mouth - I highly doubt you have an example to give at all since you've had what? 2 years in clinical, or maybe just ONE? PULEASE - 👎

 

[Poety]

Poety I liked your other pic more FWIW..

I know, but I'm grumpy Poety right now, and my preciousssss avatar can't be subjected to that 😀 😛

 

[RonaldColeman]

Having worked the cardio wards, step down and icu when you were a wee one in diapers, I seriously doubt my image is skewed and I can tell you straight from the hip - docs that have TIME to look down on others are not the best doctors out there at all - they should be worrying about their patients. This coming from mr. affirmative action 😴

And I'd like some concrete "examples" of this "looking down" that you've seen - and again, I'm not talking residents here, I'm talking straight from an attendings mouth - I highly doubt you have an example to give at all since you've had what? 2 years in clinical, or maybe just ONE? PULEASE - 👎

I'm not sure how time constraints would preclude one from thinking that they are better than someone else or that one specialty is less impressive than another. I'm also not sure what affirmative action has to do with this discussion.

I wonder if our disagreement here is due to a generational gap. Perhaps this is a relatively new phenomenon in medicine? I have noticed that the sentiment tends to be more widespread among younger atttendings.

Examples? What's the point? You'll just say I made them up. I'll humor you anyway:

Attending: what do you call the guy who graduates at the bottom of his medical school class?

Me: doctor

Attending: no. family practice.

 

[Poety]

I'm not sure how time constraints would preclude one from thinking that they are better than someone else or that one specialty is less impressive than another. I'm also not sure what affirmative action has to do with this discussion.

I wonder if our disagreement here is due to a generational gap. Perhaps this is a relatively new phenomenon in medicine? I have noticed that the sentiment tends to be more widespread among younger atttendings.

Examples? What's the point? You'll just say I made them up. I'll humor you anyway:

Attending: what do you call the guy who graduates at the bottom of his medical school class?

Me: doctor

Attending: no. family practice.

If you're attending DID say something to that affect, which I highly DOUBT, then wouldn't you have presumed this guy has some inferiority complex? I mean he was clearly a self righteous tool to say the least...And wouldn't you wonder why they actually took the time to tell you "this" as opposed to something of substance that would actually be MEANINGFUL in practice?

Whats bothering me here, is that some of these medical students seem like they are looking "up" to these types of people, like they need to "impress" them, hence God forbid, they do family med or IM - we all have our stories of how the best docs we know are family med/Im/whatever blah blah, when the reality is the scariest part would be that med students feel the need to impress these people (if they actually exist, I personally haven't run into one - not one in 13 years, boy I must GOOD at avoiding them!)

Anyway - I think I made my point.

Carry on childrens <said in chef's voice> see? I'm not THAT OLD--->