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Concerned about specialty aptitude?
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You are not alone.....
I know I deleted the original post...
My original question was whether anyone feels like there are some specialties in which they are greatly interested, but they think they might not have the right personality or potential to learn the skills.
I imagine I'm not alone
I feel that way about plastics...I like it but dont think I have the artistic ability to shape the way needed.
Plus, I am too laid back to be a surgeon!! 😀
what do you want to do?
I'm thinking either interventional radiology or pain management (following anesthesiology residency). I know Step I might eventually change those plans though...
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njbmd
Until you have gone through medicine (peds, family or internal) and surgery during third year, it's difficult to figure out if you have an "aptitude" for anything. Most PGY-1 years are so similiar (outside of the heavy procedures of surgery), that they are a springboard for many specialties.
In short, if you have the grades/board scores to get into the specialty that interests you, your residency program will make sure you "develop" the aptitude to practice.
In short, if you have the grades/board scores to get into the specialty that interests you, your residency program will make sure you "develop" the aptitude to practice.
Ok I've been thinking, how does the following logic hold up?
(1) My favorite subject to study is anatomy. Easiest for me to learn.
(2) My least favorite place to be is anatomy lab (smell/group dynamics...)
(3) My least favorite subject is biochemistry. It isn't terrible, but it's the hardest for me to learn. This knocks out the anesthesiology I mentioned before.
(4) I am absolutely not considering any surgical specialties, but I have no aversion to doing procedures.
(5) I am intrigued by imaging modalities and I like repetitive work because it can be mastered with time.
Therefore, I should be...
(1) a radiologist
(2) ?
(1) My favorite subject to study is anatomy. Easiest for me to learn.
(2) My least favorite place to be is anatomy lab (smell/group dynamics...)
(3) My least favorite subject is biochemistry. It isn't terrible, but it's the hardest for me to learn. This knocks out the anesthesiology I mentioned before.
(4) I am absolutely not considering any surgical specialties, but I have no aversion to doing procedures.
(5) I am intrigued by imaging modalities and I like repetitive work because it can be mastered with time.
Therefore, I should be...
(1) a radiologist
(2) ?
I guess my only concern about rads is this: even if I know the anatomy of the entire body well enough that I could draw all major anatomy from scratch (and I'm sure I could do it after a couple years), am I going to run into major problems when I've forgotten a lot of physiology and biochemistry? Is mastering the anatomy and getting the diagnosis or doing a procedure enough, or will I have to remember all the extra knowledge about treatment/biochemistry? I don't think my brain works in such a way that biochem/physio will ever be long term memories.
I think eventually you remember everything you need to be competent....
it is so much info to remember..
Step 1 changed my plans.
When I got my score report, I was glad I passed, but I could pretty much audibly hear doors slamming shut. It sucks.
It was a combination of not working as hard as I could have, and sucking at test-taking.
When I got my score report, I was glad I passed, but I could pretty much audibly hear doors slamming shut. It sucks.
It was a combination of not working as hard as I could have, and sucking at test-taking.
i sure hope so
Sorry to hear that, what are you looking to do now? I'm not oblivious to the competitiveness of rads and the monstrosity that is Step I, so I recognize that it could certainly change my plans as well...
The problem with your logic is that you haven't experienced (much) clinical medicine yet. You are attempting to choose a specialty based on pre-clinical criteria. There are a lot of factors you haven't considered and won't be able to until you actually try it on for real. Right now, you are trying to decide how well a given shoe will fit and feel like by looking at the specs. You may be right. However, you'll learn more when you actually try some shoes on. Don't worry about it so much. Keep moving forward. The pieces will fall into place.
For those of you saying that you are interested in pain...
have you ever actually worked with pain patients?
My God, I think I would hang myself.
have you ever actually worked with pain patients?
My God, I think I would hang myself.
Exactly. No thanks.
More generally, I think it's hard to say whether or not one has the "aptitude" or will enjoy a given specialty when one hasn't at least gotten his feet wet yet. I didn't think I'd like OB/GYN before I had gotten some practical experience in the field. During the first two years of medical school, I swore up and down that I'd never be interested in it, nor did I think I had a predilection for it. This doesn't necessary mean I'll go into that field, but it was quite a surprise to see how my pre-clinical ideas didn't amount to much in the face of actual experience.
I second what was said above - you really don't know if you will jibe with a specialty until you immerse yourself in the field, its patients, its procedures (or lack thereof), its clinical problems, and its personalities. You will be surprised at what you (dis)like.
In terms of you liking anatomy, well, most of us liked it and we are not all going to be radiologists or surgeons. There are other much more important criteria out there. You'll see once you get to clinical years. That being said, first year is a great time to kick the tires and see if you might (dis)like something. Why not spend a day in your specialty of choice, and then in one that is something that you might not be considering? You'll never know unless you get exposed.👍
In terms of you liking anatomy, well, most of us liked it and we are not all going to be radiologists or surgeons. There are other much more important criteria out there. You'll see once you get to clinical years. That being said, first year is a great time to kick the tires and see if you might (dis)like something. Why not spend a day in your specialty of choice, and then in one that is something that you might not be considering? You'll never know unless you get exposed.👍
lol. The US way of selecting residents to specialities based on scores creates a strong drive for ppl to select competitive specialities, in order to show off how brill they are. Plus, it has the added benefits of producing tons of failed, depressed narcissists with minority complexes who select specialities with a disillusioned mind. Ain't that just great. Haha, lol. 😀 Glad I don't have to deal with that. And what is so special about radiation oncology. You control a few machines, zzapp... bzzt, you don't even make them, the innovation is done by geniuses who attended caltech and MIT. 🙄
I was considering vascular surgery, but the thought of having to start off operating appendixes and doing laparoscopic surgery years in advance to qualify for vascular surgery kinda ticks me off, besides, I don't think I want to spend all my time in a job that might be OK and fun, but has no potential to make me proud of myself.
@doc snow: start residency in germany. Do your fellowship back in the US. Wouldn't that be possible?
I was considering vascular surgery, but the thought of having to start off operating appendixes and doing laparoscopic surgery years in advance to qualify for vascular surgery kinda ticks me off, besides, I don't think I want to spend all my time in a job that might be OK and fun, but has no potential to make me proud of myself.
@doc snow: start residency in germany. Do your fellowship back in the US. Wouldn't that be possible?
The challenging is that I'm the sort of person that has to have a direction in order to perform at my best. I have to have at least an idea of what I would like, even if it is misguided because I don't have the experience I need.
I'm interested in otolaryngology, internal medicine (general or if specialized then medical onc or heme/onc but who really knows right?), pediatrics, and pathology.
My strategy is to find out as much as I can about ENT because it's the most competitive and it's the one that fits in with the rest of the list the least (it's the only surgical specialty that has caught my attention). That's the direction I'm orienting myself, and I realize that the chances are high that the winds will change.
I have to have a heading, though, or I go crazy. I'm not a drifter. It makes me uncomfortable.
I'd assume the best way to "get your feet wet" in a field in your pre-clinical years is to shadow. Would you agree?
There are vascular surgery residencies where your core surgical training only lasts 2 years but I guess it is interspersed throughout your training (in contrast to 5 years and then fellowship). Is 2 years too much general surgery for you?
http://www.vascularweb.org/Resident.../New_Vascular_Surgery_Training_Paradigms.html
What the hell does that comment even mean??? If you want to do vascular surgery enough you will suck it up and do the things you need to do to get to that point. Any specialty you choose will require you to go through phases of doing things you may not be stoked about doing but the end result is what you are aiming for, isn't it? As for the whole "has no potential to make me proud of myself" comment, that is just strange and something you have to deal with on a personal level regardless of the career path you choose.
From my experience, unless someone is significantly below average (to the point of being a questionable admission to medical school), there's no field of medicine that's beyond anyone's scope of aptitude. Some residencies are harder to get IN TO, and that may be limited by test-taking aptitude. But whether you have the merit to get into a competitive residency doesnt determine whether you would have the ability to be successful in that residency.
I think for the most part, you should ignore whether would be smart/able enough to succeed inside a residency and base it on whether you would enjoy the career, enjoy the training process (however long it may be), and whether you have the aptitude to GET IN (scores etc etc).
I think for the most part, you should ignore whether would be smart/able enough to succeed inside a residency and base it on whether you would enjoy the career, enjoy the training process (however long it may be), and whether you have the aptitude to GET IN (scores etc etc).
I think the first two years the MOST certain you can be about specialty is a general understanding of how you like to spend your time. For example, does the idea of long term patient care interest you or would you be ok with treating and sending on their way? Do you enjoy working with your hands? Do you enjoy the microscopic stuff or the larger things? You can note trends like that and somewhat funnel yourself in a bit of a direction. Even then, it isn't saying much. It doesn't eliminate any specialty, it just enables you to explore some before others.
I like radiology a lot. My mom was a tech and my dad is a radiologist. I grew up surrounded by it. I think most imaging studies go beyond "cool" to damn near beautiful. I've done research in radiology. I still am not sure I will end up in radiology. Will I end up in it? Probably....I just have this sense I will end up debating between EM/Ortho/Rads, but I'm still remaining open to any possibility.
I like radiology a lot. My mom was a tech and my dad is a radiologist. I grew up surrounded by it. I think most imaging studies go beyond "cool" to damn near beautiful. I've done research in radiology. I still am not sure I will end up in radiology. Will I end up in it? Probably....I just have this sense I will end up debating between EM/Ortho/Rads, but I'm still remaining open to any possibility.
Exactly. Most of those criteria are pretty poor. I don't think any of the students in my class going into anesthesiology are big Krebs' cycle lovers...
Re: Specialty Choice. I had a huge dilemma deciding between two very different specialties, but I had to pick one.
At the end of the day (i.e. before you make your decision, sometime around the beginning of 4th year), you will need to think about the reasons why you went to medical school in the first place. This is true for any specialty - not just the two that I was deciding between. You will need to ask yourself some very soul-searching questions. What gets you excited? What do you find rewarding? How much more time are you willing to spend in training before you are actually practicing and making a living? Are you alright with not being an "expert" in a particular field, if that means having a broader scope of practice? Does the fact that you may consistently have patients with poor outcomes (e.g. death, amputation, poor quality of life, etc.) really bother you, or are you able to go home satisfied after a hard day's work? Are you OK with being limited to a particular patient population/set of procedures/area of expertise? Do you like to spend a lot of time with your patients, and have a very longitudinal relationship? Are you comfortable making fast, life-altering decisions based on little background information, or does this cause you a great deal of stress? Do you believe that, for our patients, we should continue to intervene with what many believe to be futile care just because we can "do something?" Do you want to have a regular schedule where you can raise a family under optimal conditions, or are you OK with odd and/or long hours for the remainder of your career?
These are all very important questions to ask. It is also important to remember that it's very difficult to ask a training program to "change" for you - more often than not, it is you that will be changing for the program.
I'd worry about these questions and your overall mental state/level of happiness and personal fulfillment before I'd worry about any percieved "aptitude."
This is also why I find it so troubling that so many graduating medical students choose fields like dermatology, plastic surgery, anesthesiology, and radiology to gravitate towards. I guarantee you that, if you go back and look at who they were before medical school - found out what really makes them "tick" - you'd discover that most dreamed of a patient-oriented career in pediatrics, family practice, general surgery, emergency medicine, internal medicine, ob-gyn. Perhaps the allure of the dollar and/or the nice lifestyle is just too much after 8+ years of hard work. But I wonder, after a few years of practice, how many actually feel fulfilled by their career choice? Maybe they are all very happy with their decisions, and I'm the one who just doesn't get it.
At the end of the day (i.e. before you make your decision, sometime around the beginning of 4th year), you will need to think about the reasons why you went to medical school in the first place. This is true for any specialty - not just the two that I was deciding between. You will need to ask yourself some very soul-searching questions. What gets you excited? What do you find rewarding? How much more time are you willing to spend in training before you are actually practicing and making a living? Are you alright with not being an "expert" in a particular field, if that means having a broader scope of practice? Does the fact that you may consistently have patients with poor outcomes (e.g. death, amputation, poor quality of life, etc.) really bother you, or are you able to go home satisfied after a hard day's work? Are you OK with being limited to a particular patient population/set of procedures/area of expertise? Do you like to spend a lot of time with your patients, and have a very longitudinal relationship? Are you comfortable making fast, life-altering decisions based on little background information, or does this cause you a great deal of stress? Do you believe that, for our patients, we should continue to intervene with what many believe to be futile care just because we can "do something?" Do you want to have a regular schedule where you can raise a family under optimal conditions, or are you OK with odd and/or long hours for the remainder of your career?
These are all very important questions to ask. It is also important to remember that it's very difficult to ask a training program to "change" for you - more often than not, it is you that will be changing for the program.
I'd worry about these questions and your overall mental state/level of happiness and personal fulfillment before I'd worry about any percieved "aptitude."
This is also why I find it so troubling that so many graduating medical students choose fields like dermatology, plastic surgery, anesthesiology, and radiology to gravitate towards. I guarantee you that, if you go back and look at who they were before medical school - found out what really makes them "tick" - you'd discover that most dreamed of a patient-oriented career in pediatrics, family practice, general surgery, emergency medicine, internal medicine, ob-gyn. Perhaps the allure of the dollar and/or the nice lifestyle is just too much after 8+ years of hard work. But I wonder, after a few years of practice, how many actually feel fulfilled by their career choice? Maybe they are all very happy with their decisions, and I'm the one who just doesn't get it.
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Maybe 3rd year opened their eyes. Maybe it was witnessing the mountains of paperwork, or the countless hours spent on the phone arguing with insurance reps on the phone over why the patient needs an MRI, or dealing with patient after patient who doesn't want to take responsibility for their own health and wants you to fix everything with a pill or surgery, or seeing unhappy physicians in the field they had envisioned themselves a part of...maybe it was that moment when they decided that derm, gas, or rads is right for them.
I think it is a bit ignorant of you to broadly say that more competitive fields are not "patient-oriented". Radiation oncology is overwhelmingly "patient-oriented", and I can speak from personal experience. So are many other fields such as dermatology, plastic surgery,
Furthermore, I've worked with several dermatologists and to be quite honest, they appear to be some of the happiest, most content people I've worked with...and we all know that money in the pocket doesn't equate to a smile on the face.
Perhaps I misspoke with the term "patient-oriented." This was not exactly what I meant. Of course I understand that fields like plastic surgery and dermatology are patient-oriented. However, community practice (which includes the vast majority of practicing plastic surgeons and dermatologists) tends to involve a heavy component of cosmetic and aesthetic procedures - we can debate until the cows come home about the necessity of these procedures or the psychological ramifications of not feeling cosmetically ideal, but you and I know that the reason that these fields are so popular is because they are quite lucrative. If this is what you want, then more power to you. What I was talking about, generally, but using these as examples, is how surprised I am that so many people "changed" their trajectory during the course of medical school towards these fields, and away from those specialties that truly need people to fill their slots. While this should certainly be no surprise, it's one thing to read about it on paper - it's quite another thing to actually watch it happen in front of your eyes.
Also, I was not necessarily talking about the more comptitive and/or traditionally higher-paying fields like rad onc or neurosurgery. As a matter of fact, I don't recall mentioning rad onc at all. I was not insulting you or your specialty, nor do I think my POV is particularly "ignorant." I am seeing many of my classmates flocking to fields like radiology, anesthesiology, and dermatology. These specialists are certainly necessary and no doubt fill very important niches. However, what we need is more physicians in other critical roles. What I was commenting on was the disproportionately large number of students aiming for these particular specialties, and forgoing their original plans (IM, peds, surg, EM, etc.) It's more of a general lament than picking on any specific group. Shouldn't I find it disconcerting that over 10% of my class is applying in radiology? A similar number in anesthesiology? Once again, I repeat - I am not saying that these specialists are unnecessary or unimportant. But, for example, do we really need that many radiologists?
ONCE AGAIN, for those of you who are quick to take offense (which seems to encompass 95% of SDN members) - I am not trying to pick on one particular group. I am merely using examples to illustrate a much larger problem. I am also all for doing what you want to do - if you simply want to make money, or live a specific lifestyle, or just do cosmetic procedures day-in and day-out, then that's your prerogative. If you can get into med school, do well enough in classes and on exams to match into a particular specialty, and decide that's what you want, then you have the right to do whatever you want to do. I was just commenting on the fact that many of you and your classmates start out medical school feeling a certain way about medicine, and then, at the end of the day, something changes your mind and your career goals. As I said before, I find it troubling. That's all.
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I hope to follow this. Like the OP, I am also fascinated by radiology. However, I know I inherently have the tendency to think too far ahead (I'm quite a planner). The best plan for me is probably to first and foremost focus on pre-clinicals and learning the information as thoroughly as possible. And then direct my efforts to doing well on Step 1... the rest is probably too far ahead to think about. Baby steps 🙂 Also, maybe it is good to have some general ideas for 2nd and 3rd choice going into 3rd year in case radiology isn't a good fit.
I dunno. I never really started medical school thinking surgery or IM or FM or peds off the bat. I did a pretty good job of keeping an open mind, and at the end of the day anesthesiology is the most appealing field. It's not a matter of changing my career goals, or not wanting to work with patients (wtf, every doctor affects patients). As my wife likes to say about her chosen specialty (also on your "list"), I would rather make primary care money to be an anesthesiologist than anesthesiologist money to be a primary care doctor.
I understand what you are saying about medical students tending to choose more specialties than primary care. But it's not a problem with the medical students "straying from the path," it's a problem with the system. Compared to yesteryear, new doctors have insane amounts of debt, higher patient loads, and less autonomy/more control by HMOs telling you what you can/can't order. You have to treat the underlying disease, not the symptoms, if you want to get more medical students back into primary care.
And that's fine. There's nothing wrong with knowing what you want. And we need anesthesiologists, just like we need all kinds of docs. I guess I wasn't really talking about students like you.
I never once commented on the "cause" of medical student career choices - the reasons are multiple and complex. And I never placed any blame on the students themselves - there's really no blame to be had. I only commented that it is disconcerting to actually see it in practice. It does and should bother me that 18 people out of a class of 160 are applying in radiology, but only 3 in ob/gyn, for example. And I understand completely how perceived notions of debt, patient load, autonomy, and control by other entities affect specialty choice - I'm applying this year as well. These factors definitely weighed on my choice - but so did my overall happiness and my reasons for going into medicine in the first place. This thread is about "specialty aptitude" and my original point is that these internal factors are much more important in the long run than any perceived aptitude. I think that most of us could be assigned randomly to any medical specialty and eventually become "apt" enough to practice - but, since it's not random, you can pick and choose based on other criteria. Again, I am not making an statement about or an attack on the character of students who choose specific fields. I don't understand why so many feel the need to get so defensive about it. It's just an observation.
You claim you are not attacking the character of students who choose specific fields, yet you discuss convenience factors and other choices that students take into account when choosing a specialty versus choosing one based on these 'internal factors' that we might assume consist of 'the real reasons for going into medicine in the first place'. You also mention how the proportion of selections of specialties bothers you. There is a disconnect there. You don't say it directly, but whether you intend to or not, you project "I don't like that some people are choosing specialties for reasons 'less honorable' than caring for patients"
18/160 and 3/160 consist of a sample of 1 and could very well be biased.
I think most of us (or at least I) aren't getting defensive, we're just responding to your observations. Just because I happen to disagree with you doesn't mean I'm taking it personally.
As for the bolded part, I think my point is that "overall happiness" and "reasons for going into medicine in the first place" are tied to those "other factors." Many people's "reasons for going into medicine in the first place" were to help people, have some autonomy over their career, and have a stable lifestyle. And those factors are in many ways under attack, as I listed. And since those "reasons for going into medicine in the first place" are being compromised, their "overall happiness" is being affected.
Overall, I agree with your point that specialty aptitude has very little to do with what career field you go into. Almost anybody can be taught the basic skills for each field. You might not be able to make anyone into a world-renowned pediatric cardiac surgeon, but the vast majority of people could "cut it" in general surgery. The bigger question is what kind of "personality aptitude" someone has.
While I agree that some people choose their specialty for "other" reasons, such as time commitment and money, I think it's less common than you might think. I actually don't personally know anyone who chose a field they liked considerably less because of these reasons, and I go to a school that is very specialist-heavy.
Honestly, come rotations, I was surprised at how much I hated doing H&Ps, writing up notes, spending 20 minutes talking about one aspect of patient X's care, and standing for hours in the OR. I came into med school leaning towards Ob/Gyn or emergency medicine. I couldn't have predicted I was going to dislike the things I thought would fit me well (e.g. continuity of care, procedures), nor could I have predicted that radiology was going to turn out to be the perfect fit for me. And it's not because I "hate patients", because I don't...radiology is just what excited me the most in med school and I can't wait to do it for the rest of my life (if, you know, some residency will have me).
I know n=1 (or n=2, if you include WLG7), but my whole point is that I think more people go into specialties for the right reasons than the "wrong" ones. Or at the very least, they go into specialties they would enjoy doing, even if some of those other factors played a role in their decision. And there's nothing wrong with that.
Honestly, come rotations, I was surprised at how much I hated doing H&Ps, writing up notes, spending 20 minutes talking about one aspect of patient X's care, and standing for hours in the OR. I came into med school leaning towards Ob/Gyn or emergency medicine. I couldn't have predicted I was going to dislike the things I thought would fit me well (e.g. continuity of care, procedures), nor could I have predicted that radiology was going to turn out to be the perfect fit for me. And it's not because I "hate patients", because I don't...radiology is just what excited me the most in med school and I can't wait to do it for the rest of my life (if, you know, some residency will have me).
I know n=1 (or n=2, if you include WLG7), but my whole point is that I think more people go into specialties for the right reasons than the "wrong" ones. Or at the very least, they go into specialties they would enjoy doing, even if some of those other factors played a role in their decision. And there's nothing wrong with that.
MrBurns, I certainly respect your opinion and I agree with you 100% about how much the actual day-to-day practice of a specific field of medicine experienced during rotations can really turn you on/off to a specialty, despite any preconceived notions of fame/fortune/prestige/flexibility/autonomy/younameit. But, in my experience, at least, it seems that time commitment and money are the #1 reasons why medical students choose particular fields. And from meeting and talking people on the interview trail, it seems that this phenomenon is not specific to my school. Once again, I repeat - there's nothing wrong with wanting those things.
I am obviously addressing a board filled with aspiring specialists, so I guess it shouldn't surprise me that so many people are reacting negatively to what I have to say. I'm not really sure how you can "disagree" with my observation that the applicants of my graduating class is heavily weighted towards certain specialties (if we're talking percentage of the total class vs. percentage of the general population of physicians needed) and not towards others. It is what it is. Perhaps you meant that you disagree with my reaction or analysis of the situation - and that's fine. You are entitled to believe whatever you want to believe, and to pursue whatever field of medicine you are able and willing to. Regardless, I still find it disconcerting that I'll have plenty of specialists available to read my CXR, treat my rash, or monitor my vitals in the OR, but have difficulty finding someone to deliver my high-risk baby, remove my infected appendix, or manage my elderly parents in the clinic or ICU.
PS. Every time I see your screenname and avatar, this is what runs through my head:
"Are they booing me?"
"Err...no! They're saying...'boo-urns! Boo-urns!'"
"Are you saying 'boo,' or 'boo-urns'?"
"BOOOOOOOOO!!!!"
"...I was saying 'boo-urns..."
I agree with LadyWolverine in that the issue of students going into non-primary care fields troubles me.
While Dral, Burns, and others make valid points, I'm still troubled, and unconvinced.
Hanging around the SDN, and talking to new med students, Ive come to think that there are two major flight patterns of new med students. 1. Bound for "patient oriented" primary care fields, for many of what one might call a noble reasons. 2. Exciting, lucrative, consulting roles (IR, Int.Cards...). Then theres the minority who keep an open mind. Few could join med school with a truly open mind - how can you know you want to do medicine if your mind is truly open? You must have some idea of what medicine means to you.
Given that most start med school with a pre-conceived flight pattern, notice that the student's own feeling of what field they fit best in can't usually play a role (unless they used to be a medic or RN). So, the initial flight pattern is based purely on cognitive assumptions about the field, and the students insight into themselves.
Focusing on the students on flight pattern #1... What gets students off the primary care, patient centered, continuity of care, being part of the patient's life, focus?
I think, most of the time it is in fact, money, lifestyle, hours, paperwork, overwhelming fund of knowledge of a generalist etc. coupled with a shiny new field.
In other words... "I fit well with XYZology, because I'm fascinated by the XYZ (bcs I cant be fascinated by every body part equally). I find that I like OP medicine (because I hate rounds). I find that at the end of the day Im a happer person (because i leave at 6pm in my BMW and dont have 3 hours of paperwork to do).
The unique attributes of the shiny new field are a plus, and the absence of the unspoken drawbacks of the forsaken field make the new field even MORE fitful. Whether the student realizes them or not. And in the end, there are twice as many reasons to avoid the much needed primary care fields, and we arent always cognitively aware of them (negative reinforcement).
While Dral, Burns, and others make valid points, I'm still troubled, and unconvinced.
Hanging around the SDN, and talking to new med students, Ive come to think that there are two major flight patterns of new med students. 1. Bound for "patient oriented" primary care fields, for many of what one might call a noble reasons. 2. Exciting, lucrative, consulting roles (IR, Int.Cards...). Then theres the minority who keep an open mind. Few could join med school with a truly open mind - how can you know you want to do medicine if your mind is truly open? You must have some idea of what medicine means to you.
Given that most start med school with a pre-conceived flight pattern, notice that the student's own feeling of what field they fit best in can't usually play a role (unless they used to be a medic or RN). So, the initial flight pattern is based purely on cognitive assumptions about the field, and the students insight into themselves.
Focusing on the students on flight pattern #1... What gets students off the primary care, patient centered, continuity of care, being part of the patient's life, focus?
I think, most of the time it is in fact, money, lifestyle, hours, paperwork, overwhelming fund of knowledge of a generalist etc. coupled with a shiny new field.
In other words... "I fit well with XYZology, because I'm fascinated by the XYZ (bcs I cant be fascinated by every body part equally). I find that I like OP medicine (because I hate rounds). I find that at the end of the day Im a happer person (because i leave at 6pm in my BMW and dont have 3 hours of paperwork to do).
The unique attributes of the shiny new field are a plus, and the absence of the unspoken drawbacks of the forsaken field make the new field even MORE fitful. Whether the student realizes them or not. And in the end, there are twice as many reasons to avoid the much needed primary care fields, and we arent always cognitively aware of them (negative reinforcement).
This thread has been relatively civil, and I hope to keep it that way. But I wanted to mention that statements such as "I've worked with several dermatologists and to be quite honest, they appear to be some of the happiest, most content people I've worked with...and we all know that money in the pocket doesn't equate to a smile on the face. " are what Im talking about. Why are Derms happy and content? Its not just about money. Its about money, cars, hours, paperwork, smelly patients, rounds, comorbidity management, memorizing HTN and DM alogorithms... etc. All of it. Of course Derms are the happiest, they even have the luxury of not having to deal with managed care. I'll never believe that making a 16 year old girl feel pretty is your existential goal in life. It might make you feel good, along with the dozens of other bonuses, which you may or may not recognize. You may not even notice that you back doesn't hurt at the end of the day... why should you notice something that you dont have?
Similarly "I think it is a bit ignorant of you to broadly say that more competitive fields are not "patient-oriented". Radiation oncology is overwhelmingly "patient-oriented", and I can speak from personal experience. So are many other fields such as dermatology, plastic surgery" While I think RadOnc is great, it is not overwhelmingly patient oriented. Peds and IM are. RadOnc is overwhelmingly scientific... where your day is spent in the computer and inside your own brain. The huge amount of procedures involved does not make it "patient oriented", nor does the patient education. Not even the psychological counselling given by RadOncs every day to our sickest patients, which I feel rivals that of psychiatrists at times, makes it an overwhelmingly patient oriented field.
Even less so for fields like Plastics and IR, for example. The consultation before and after the patient is anesthetized doesn't make it patient oriented. Each of these fields have a specific job to do. And that job is not to be the primary physician.
Similarly "I think it is a bit ignorant of you to broadly say that more competitive fields are not "patient-oriented". Radiation oncology is overwhelmingly "patient-oriented", and I can speak from personal experience. So are many other fields such as dermatology, plastic surgery" While I think RadOnc is great, it is not overwhelmingly patient oriented. Peds and IM are. RadOnc is overwhelmingly scientific... where your day is spent in the computer and inside your own brain. The huge amount of procedures involved does not make it "patient oriented", nor does the patient education. Not even the psychological counselling given by RadOncs every day to our sickest patients, which I feel rivals that of psychiatrists at times, makes it an overwhelmingly patient oriented field.
Even less so for fields like Plastics and IR, for example. The consultation before and after the patient is anesthetized doesn't make it patient oriented. Each of these fields have a specific job to do. And that job is not to be the primary physician.
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I'm going to have to disagree with this one. As someone who has seen dermatologists during my teenage years, those appointments weren't just about making me "feel pretty". It was about being empowered enough to do something about what bothered me and that confidence helped me in so many ways. Let's not dismiss any physician's contribution. The derms do have it easier than a primary healthcare provider. Instead of focusing on the disparity between fields, maybe we should focus on making primary care being a better field... by making it more reasonable and less stressful for those who aspire to go into it. THAT is what needs to be tackled. Then I'm sure more people will follow through with their desire to go into primary care.
Though its not the point of this thread... that's exactly what my tongue-in-cheek point was. Dermatologists don't just cure acne. They help 16 year old girls "feel pretty", thereby empowering them, and giving them confidence to improve their own psychosocial development.
I'm recognizing that a byproduct of what they do is to improve the psychosocial development of teenagers, and dismissing it. If this was what made them "tick" they might consider a career in child/adolescent psychiatry, which is the most in-demand specialty in the US, and pays pretty well too. But not as much as Derm.
Using this motivation to justify an interest in Derm is just putting lipstick on a pig. I believe that in a previous discussion it was Dral who had offered some very valid and insightful reasons for choosing Derm. And if I recall, improving the self-esteem of teenage girls wasn't one of them
Hmmm true. Child/adolescent psychiatry would probably bring someone more satisfaction if that's a top reason for going into derm. The point about valid and insightful reasons leads me to propose another question. How can we classify some reasons as being more valid than others? Of course, one can suggest that child and adolescent psychaitry will be a more rewarding job for that person. But the ultimate decision is up to the individual. I don't think we would be as concerned with reasons (provided that patients are happy and well-cared for) if it weren't for the huge deficit in primary care.
HJ, I for one appreciate your comments and it's nice to know that I'm not the only one.
I should probably add that I go to a state school that has historically trained the majority of physicians that practice in this state. 3 Ob/Gyns out of 160+? 3 psychiatrists? A handful of pediatricians? On the flip side, 18 radiologists? 14 anesthesiologists? 6 dermatologists? 7 orthopedists? 8 people matched in urology last year. Is the penis really that interesting/rewarding? (OK, don't answer that. I just realized how badly I set myself up.)
Do you see now where my concern comes from? These statistics scare me, even if they are a tiny snapshot of the nation as a whole. And, once again - I am not knocking ANY INDIVIDUAL'S decision to pursue a particular field. Your reasons, motivations, and abilities are your own, and nobody can or should take that away from you. I'm not talking about individuals - I'm talking about populations and trends. This showcases quite well the problem that this country is facing. If everyone wants either the command posts or the "cushier" jobs, who is left in the trenches to do the dirty work? Or, as HJ put it, the "paperwork, smelly patients, rounds, comorbidity management, memorizing HTN and DM alogorithms..."??
I look at it like the Nurse Practitioner degree, and their push out of the actual nursing-RN-workhorse and into something a lot less "dirty" and visceral. It seems like a lot of aspiring docs are also moving along a similar path. Nobody wants to be the primary workhorse anymore - to many (after 4 years of medical school), that kind of work is not particularly glamorous, lucrative, or rewarding (depending on your definition) anymore. It is much better to be in a specialist field.
And for those who are quick to react - I'm just as guilty. I'm not going into a primary care field (although it is becoming more and more so...but I actually rather like that element of medical practice, so I guess it's the perfect fit for me). So, once again. This is not a personal attack on any one field or group of students.
Match day will be very telling.
I should probably add that I go to a state school that has historically trained the majority of physicians that practice in this state. 3 Ob/Gyns out of 160+? 3 psychiatrists? A handful of pediatricians? On the flip side, 18 radiologists? 14 anesthesiologists? 6 dermatologists? 7 orthopedists? 8 people matched in urology last year. Is the penis really that interesting/rewarding? (OK, don't answer that. I just realized how badly I set myself up.)
Do you see now where my concern comes from? These statistics scare me, even if they are a tiny snapshot of the nation as a whole. And, once again - I am not knocking ANY INDIVIDUAL'S decision to pursue a particular field. Your reasons, motivations, and abilities are your own, and nobody can or should take that away from you. I'm not talking about individuals - I'm talking about populations and trends. This showcases quite well the problem that this country is facing. If everyone wants either the command posts or the "cushier" jobs, who is left in the trenches to do the dirty work? Or, as HJ put it, the "paperwork, smelly patients, rounds, comorbidity management, memorizing HTN and DM alogorithms..."??
I look at it like the Nurse Practitioner degree, and their push out of the actual nursing-RN-workhorse and into something a lot less "dirty" and visceral. It seems like a lot of aspiring docs are also moving along a similar path. Nobody wants to be the primary workhorse anymore - to many (after 4 years of medical school), that kind of work is not particularly glamorous, lucrative, or rewarding (depending on your definition) anymore. It is much better to be in a specialist field.
And for those who are quick to react - I'm just as guilty. I'm not going into a primary care field (although it is becoming more and more so...but I actually rather like that element of medical practice, so I guess it's the perfect fit for me). So, once again. This is not a personal attack on any one field or group of students.
Match day will be very telling.
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I completely understand what you mean, and you absolutely make valid points. To be honest, I'm not sure exactly where I stand on the issue. I remember talking to WLG7 earlier about applicants that decided to apply to radiology primarily because of the time and money, and the idea pisses me off. I feel like they're taking that spot away from someone who actually loves radiology (this really exists!) and that's not fair. But he replied that it shouldnt matter why someone goes into a field so long as they do a good job in it and always put the patient first. And as much as I hate to admit it, I guess he's right.
It does still bother me some, so I do understand where you're coming from. Something has to change about primary care...I'm not sure what or how, but something has to be done before PAs and NPs take over that job market entirely.
P.S. That's one of my favorite lines from the Simpsons. Excellent reference!
