Confused about what to do with my life

[arb011]

Hey Everyone. I am just about to start my 4th year and I am all over the place with trying to decide what to go into. For about the last year I have been convinced that I am going into one of the surgical sub-specialties. However, I am not nearly competitive enough and I have discovered that there are many things involved in the specialty that I do not want. Ultimatley I have decided to persue internal med. I love the variety and ability to use all of your medical knowledge. However, I LOVE operating. I guess my question is, if I start in one residency (say IM) and discover that I made the wrong decision, is it unheard of or very difficult to change specialties?

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[danzman]

Hey Everyone. I am just about to start my 4th year and I am all over the place with trying to decide what to go into. For about the last year I have been convinced that I am going into one of the surgical sub-specialties. However, I am not nearly competitive enough and I have discovered that there are many things involved in the specialty that I do not want. Ultimatley I have decided to persue internal med. I love the variety and ability to use all of your medical knowledge. However, I LOVE operating. I guess my question is, if I start in one residency (say IM) and discover that I made the wrong decision, is it unheard of or very difficult to change specialties?

While not impossible, it becomes a big problem when dealing with funding (search around in the gen res forums for all sorts of info about "the clock"). And you would have to start over from scratch pretty much. The whole "I love to operate" thing gets thrown around a lot, what about it did you enjoy?

At the end of the day it like my old man told me "Dont say what you want to be, say what you do for the next 40 yrs." Do you like calling yourself a surgeon, or can you really see yourself doing the job of a surgeon for the next 40years? I loved being in the OR and tying knots, but I could never do that crap for 40years.

 

[anonperson]

Hey Everyone. I am just about to start my 4th year and I am all over the place with trying to decide what to go into. For about the last year I have been convinced that I am going into one of the surgical sub-specialties. However, I am not nearly competitive enough and I have discovered that there are many things involved in the specialty that I do not want. Ultimatley I have decided to persue internal med. I love the variety and ability to use all of your medical knowledge. However, I LOVE operating. I guess my question is, if I start in one residency (say IM) and discover that I made the wrong decision, is it unheard of or very difficult to change specialties?

Do you like operating or do you like doing procedures?

If it's the OR, try matching into general surgery. It's not an easy match but easier than ENT, Ophtho, Urology etc.

If it's procedures, then stick with IM and attempt for a fellowship in GI or cards.

It's not unheard of changing specialties. It is challenging though as you will be interviewing during your intern year (with all of the headache that goes with it). And you also have to realistically assess your chances at matching as well.

 

[Groove]

Just don't match into the "specialty of indecisiveness" as I like to call it...better known as Med-Peds.

Oh damn, I opened myself up to some flaming on that one.

 

[error404]

I don't know why people who want to do surgery but consider themselves poor candidates always consider medicine as an alternative. Just because it's easier to get into doesn't mean you'll be an asset to the field. It's insulting to internal medicine to insist it takes the surgical failouts.

If you want to do surgery, do surgery. Work on becoming a stronger candidate. Don't doom yourself to decades of misery sitting in clinic when you'd rather be in the OR.

Perhaps it's naive of me not to understand why someone would feel limited-- but you don't do yourself or your patients any favors by going into a specialty you're not interested in.

 

[arb011]

I don't know why people who want to do surgery but consider themselves poor candidates always consider medicine as an alternative. Just because it's easier to get into doesn't mean you'll be an asset to the field. It's insulting to internal medicine to insist it takes the surgical failouts.

If you want to do surgery, do surgery. Work on becoming a stronger candidate. Don't doom yourself to decades of misery sitting in clinic when you'd rather be in the OR.

Perhaps it's naive of me not to understand why someone would feel limited-- but you don't do yourself or your patients any favors by going into a specialty you're not interested in.

I would not be using medicine as a fallback. I have genuine interest in the field and for this reason it should not be insulting that I am considering it. In addition, competitiveness is not my only reason for not wanting to go into this particular surgical-specialty. I desire a comprehensive scope of medicine and the ability to use my hands to improve the quality of life of patients. This may piss some people off, but I am not willing to sacrifice myself to the extent required to do general surgery. I know many people are, and I am grateful for them.

I apologize for all of the negativity and whining. I have felt very confused and lost. After some intense reflection I have decided to do EM. In the right setting it has most of the things I desire; the ability to help critically ill patients both medically and procedurally, flexibility in working hours (for the most part), and the opportunity to use a comprehensive medical knowledge base to help some people who really need it.

Sorry if you read this. I guess it was just more self-reflection and will have no benefit to most people.

 

[MJB]

I would not be using medicine as a fallback. I have genuine interest in the field and for this reason it should not be insulting that I am considering it. In addition, competitiveness is not my only reason for not wanting to go into this particular surgical-specialty. I desire a comprehensive scope of medicine and the ability to use my hands to improve the quality of life of patients. This may piss some people off, but I am not willing to sacrifice myself to the extent required to do general surgery. I know many people are, and I am grateful for them.

I apologize for all of the negativity and whining. I have felt very confused and lost. After some intense reflection I have decided to do EM. In the right setting it has most of the things I desire; the ability to help critically ill patients both medically and procedurally, flexibility in working hours (for the most part), and the opportunity to use a comprehensive medical knowledge base to help some people who really need it.

Sorry if you read this. I guess it was just more self-reflection and will have no benefit to most people.

Sounds to me like you should go Gen Surg or FP.

I understand liking a surgical subspecialty but not GS. God Bless the people that go into that field. I liked URO but discovered it got pretty repetitive. Like most specialties.

 

[danzman]

I don't know why people who want to do surgery but consider themselves poor candidates always consider medicine as an alternative. Just because it's easier to get into doesn't mean you'll be an asset to the field. It's insulting to internal medicine to insist it takes the surgical failouts.

If you want to do surgery, do surgery. Work on becoming a stronger candidate. Don't doom yourself to decades of misery sitting in clinic when you'd rather be in the OR.

Perhaps it's naive of me not to understand why someone would feel limited-- but you don't do yourself or your patients any favors by going into a specialty you're not interested in.

In all fairness, and not that this has anything to do with the OPs situation, but for students who are not competitive in GS what else is there? I see FM, IM, Psych, and Peds. Surg kinda self selects for people who are interested in that type of life, and if you are not competitive for gen surg, then you are probably not competitive for things that would appeal to that person. IM probably opens the most doors in medicine, so why would a person not go in that direction? Sure you can work on being more competitive etc' but at some point you may have to be resonable about your chances/options.

 

[anonperson]

I don't know why people who want to do surgery but consider themselves poor candidates always consider medicine as an alternative. Just because it's easier to get into doesn't mean you'll be an asset to the field. It's insulting to internal medicine to insist it takes the surgical failouts.

If you want to do surgery, do surgery. Work on becoming a stronger candidate. Don't doom yourself to decades of misery sitting in clinic when you'd rather be in the OR.

Perhaps it's naive of me not to understand why someone would feel limited-- but you don't do yourself or your patients any favors by going into a specialty you're not interested in.

I don't see it as settling. Some people may have a true interest in surgery but because of board scores etc they will not have a good chance at matching and will potentially never be a "good enough" candidate

IM at least has a bunch of different options and as a whole is pretty interesting.

 

[Tius]

arbo11, i felt the same way as you did beginnig 4th year. I originally wanted to do ortho but was always interested in cards. I know, wildly different. I enjoyed working with my hands, was very mechanically inclined and heard of all the cool procedures ortho has. But like you, I also didn't want to lose practice of the medical knowledge you learn. What made the deal breaker? An intern at the time told me not to focus on what you like about each field but focus on what you can't stand about it. If you can deal with it for the next 40 years, then there you have it. Me? Couldn't stand the work hours of a surgeon, didnt' like the culture as much, nature of problems you encountered on call i.e. mostly trauma wasn't that interesting to me. So that ruled out surgery.

Think about it this way, are you willing to get up and be there at 5 to round on your patients, go to oOR at 7, operate all day, maybe or maybe not have lunch at a decent time, if at all, come out of the OR 4-5, round again on postop patients, get home late, and do it all over again? If the answer is no, then you probably don't like OR as much as you'd think.

Hope it helps

 

[DrVanNostran]

arbo11, i felt the same way as you did beginnig 4th year. I originally wanted to do ortho but was always interested in cards. I know, wildly different. I enjoyed working with my hands, was very mechanically inclined and heard of all the cool procedures ortho has. But like you, I also didn't want to lose practice of the medical knowledge you learn. What made the deal breaker? An intern at the time told me not to focus on what you like about each field but focus on what you can't stand about it. If you can deal with it for the next 40 years, then there you have it. Me? Couldn't stand the work hours of a surgeon, didnt' like the culture as much, nature of problems you encountered on call i.e. mostly trauma wasn't that interesting to me. So that ruled out surgery.

Think about it this way, are you willing to get up and be there at 5 to round on your patients, go to oOR at 7, operate all day, maybe or maybe not have lunch at a decent time, if at all, come out of the OR 4-5, round again on postop patients, get home late, and do it all over again? If the answer is no, then you probably don't like OR as much as you'd think.

Hope it helps

Good points, but...

Most of what you said is the life of resident or fellow. If you are an attending in surgery, the lifestyle is not to bad if you get with a large group or go in academics. Life of a surgical resident is definitely tough, but life of an attending is arguably better than someone in internal medicine. On OR days, you may be done by 2-3, have most weekends off.

I can't stand the way residents round in internal medine, but as an attending it probably won't be that bad. Just my 2 cents.

 

[Winged Scapula]

Good points, but...

Most of what you said is the life of resident or fellow. If you are an attending in surgery, the lifestyle is not to bad if you get with a large group or go in academics. Life of a surgical resident is definitely tough, but life of an attending is arguably better than someone in internal medicine. On OR days, you may be done by 2-3, have most weekends off.

I would venture that you have not experienced the full gamut of what life may be like as a surgical attending. I am in a lifestyle specialty and I can tell you, that even I, am not done by 2-3 most days, nor do I have weekends off always. My colleagues in non lifestyle surgical specialties, definitely do not have such a lifestyle, even those in academics.

Remember just because you aren't in the OR doesn't mean you are working. Paperwork, consults, office hours, more paperwork, rounding, etc. take up a lot of time.

I suspect that your experience is an anomaly.

 

[DrVanNostran]

I would venture that you have not experienced the full gamut of what life may be like as a surgical attending. I am in a lifestyle specialty and I can tell you, that even I, am not done by 2-3 most days, nor do I have weekends off always. My colleagues in non lifestyle surgical specialties, definitely do not have such a lifestyle, even those in academics.

Remember just because you aren't in the OR doesn't mean you are working. Paperwork, consults, office hours, more paperwork, rounding, etc. take up a lot of time.

I suspect that your experience is an anomaly.

N=2 academic institutions with close family at each.

My brother is a NS attending at pretty big academic place. His group basically takes weekend call once every 6 weeks, unless he is on spine then its 2x time in 6 weeks. He has 3 OR days and 2 clinic days. Clinic days are definitely long. Depending on his case load, he is out pretty by 5 on most OR days, but there are days when he doesn't come out till late definitely. But with my experience at his place, life is definitely not that bad IMO. Other place is my cousin who is a surg-onc. He is a bit busier since his group is smaller. The surgery attendings I talked to all said that they are definitly busy, but it is very managable.

 

[Winged Scapula]

N=2 academic institutions with close family at each.

My brother is a NS attending at pretty big academic place. His group basically takes weekend call once every 6 weeks, unless he is on spine then its 2x time in 6 weeks. He has 3 OR days and 2 clinic days. Clinic days are definitely long. Depending on his case load, he is out pretty by 5 on most OR days, but there are days when he doesn't come out till late definitely. But with my experience at his place, life is definitely not that bad IMO. Other place is my cousin who is a surg-onc. He is a bit busier since his group is smaller. The surgery attendings I talked to all said that they are definitly busy, but it is very managable.

It *is* manageable, depending on one's definition of such.

However, again I fear that your experience is not relevant to the practice of surgery in most cases.

It sounds as if your brother does Neurospine with a very large group. That reduces his call significantly, and most spine work is elective. By your own admission, he is not "done by 2-3 most (OR) days" but rather 5 pm or even later. And while Surg Onc patients can be very ill, it is also a highly elective practice, almost always practice in an academic institution with residents reducing the amount of cases done/hours worked/phone calls received.

My point is that while your experience is valid, I fear that students reading this will assume that represents the whole field. The American College of Surgeons reports that most surgeons in the US are in practice in groups of less than 5 surgeons, working an average of 62 hours/week.

 

[deuist]

Other than the plastic surgeons, I can't think of any attendings who had a great lifestyle Maybe the colorectal guys did. Their work was largely elective and they did lots of office-based procedures. Given that we had a fellowship, however, the fellow had to take the phone calls during the middle of the night. I imagine the hours would have been worse for the attendings had he not been there.

The trauma attendings had to take Q4 in-house call and worked the same 80-hour work weeks that the residents did.

Vascular seemed like hell on earth...

 

[DrVanNostran]

Good points, but...

Most of what you said is the life of resident or fellow. If you are an attending in surgery, the lifestyle is not to bad if you get with a large group or go in academics. Life of a surgical resident is definitely tough, but life of an attending is arguably better than someone in internal medicine. On OR days, you may be done by 2-3, have most weekends off.

I can't stand the way residents round in internal medine, but as an attending it probably won't be that bad. Just my 2 cents.

It *is* manageable, depending on one's definition of such.

However, again I fear that your experience is not relevant to the practice of surgery in most cases.

It sounds as if your brother does Neurospine with a very large group. That reduces his call significantly, and most spine work is elective. By your own admission, he is not "done by 2-3 most (OR) days" but rather 5 pm or even later. And while Surg Onc patients can be very ill, it is also a highly elective practice, almost always practice in an academic institution with residents reducing the amount of cases done/hours worked/phone calls received.

My point is that while your experience is valid, I fear that students reading this will assume that represents the whole field. The American College of Surgeons reports that most surgeons in the US are in practice in groups of less than 5 surgeons, working an average of 62 hours/week.

My statement probably did come off generalized due to the nature of talking on a forum. But I wanted to emphasize that there are opportunities for a decent lifestyle if you choose to and find the right group.

My brother is at a cancer center where he is fellowship trained in both complex spine and did a year of neurosurgical oncology. He isn't doing ACDFs all day long lol, but spinal tumors, decompressions, with brain tumors mixed in. But since the group is so large and diverse, they are able to work out a decent schedule where on some OR days he gets out at 2-3. But there are definitely days when he comes home around midnight due to complex cases or an emergent case. I was fortunate to spend a significant time with him and essentially live the attending lifestyle. Like I said my experience is only limited to him, my cousin, and my university which happens to be a smaller program (still level one).

But I do agree with you that most surgeons live a much busier life than others.

BTW-I hope you don't think I am arguing with you or being douchebagish. I just wanted to clarify what I meant

 

[PistolPete]

Basically, OP, you like procedures, but also want (or at least seem to want) a good mix of IM. I agree that you should go for gen surg, if that's what you really want and can see yourself doing for 40 years. But have you thought about Anesthesia? PMR--> pain fellowship? Have you ruled those out?

Good luck!

 

[Winged Scapula]

BTW-I hope you don't think I am arguing with you or being douchebagish. I just wanted to clarify what I meant

No worries. Thanks for the clarification.

 

[mp2100]

While not impossible, it becomes a big problem when dealing with funding (search around in the gen res forums for all sorts of info about "the clock"). And you would have to start over from scratch pretty much. The whole "I love to operate" thing gets thrown around a lot, what about it did you enjoy?

At the end of the day it like my old man told me "Dont say what you want to be, say what you do for the next 40 yrs." Do you like calling yourself a surgeon, or can you really see yourself doing the job of a surgeon for the next 40years? I loved being in the OR and tying knots, but I could never do that crap for 40years.

Can someone elaborate on the "funding issue" described above?

 

[hot sauce]

Can someone elaborate on the "funding issue" described above?

I believe after a certain number of years of graduate medical education (7?) the federal government will no longer pay the hospital for you to be a resident. So you are significantly less attractive if have enough priors years so that you won't be funded throughout the residency you applying to.

 

[Smurfette]

I believe after a certain number of years of graduate medical education (7?) the federal government will no longer pay the hospital for you to be a resident. So you are significantly less attractive if have enough priors years so that you won't be funded throughout the residency you applying to.

Not quite. I'm simplifying this (do a search of the forums for more details) but the number of years of training for whatever program you match into is the number of years of funding you get. i.e. IM, peds, FP=3 years, anesthesia, psych = 4 years, GS, GU, ortho, ENT, rads=5 years, etc. Once you've used up those years of funding, your program gets less money from the govt to support your training.

 

[mp2100]

Thanks for the information. Sounds like decreases in funding will definitely make it harder for people to switch into different residency specialties.