MD & DO Confusion About Specialties

[deleted407021]

Hey y’all, long post incoming.

3 rotations into third year and it’s about time for a weird crisis of identity and slowly brewing panic about which specialty I want to go into and how to prepare. Obviously I don’t tolerate long term uncertainty very well.

I’ve always been interested in psych. I majored in psychology in undergrad and the mental and social elements of wellness along with all the theories are things I can geek out about endlessly. I’m really fascinated by it. However, I’m not sure how much I will like the field in practice. A few of the mentally ill patients I’ve encountered in my primary care rotations have been interesting but one case was less fascinating and more unsettling. I didn’t want to spend any more time with this non-verbal, self-soiling patient than I needed to and it occurred to me that a case like that could be bread and butter for psych in many settings. I have a good amount of personal experience of how mental illness can affect people within my family and I would loving having a part of people living happier more rewarding lives. So I’m unsure.

Some things I’ve learned:
- I don’t like primary care. It feels like managing decay.
- I don’t like adult medicine. Vaguely numb feet and playing with numbers and telling people for the 500th time to stop X unhealthy behavior is not compelling
- A lot of basic medicine isn’t compelling work. Memorizing lab value ranges and guidelines and adjusting meds based on small number changes gives me a headache.
- Kids are way more interesting than adults and I loved my peds rotation but I don’t find them cute and I don’t think I can keep the warm and jolly thing going very long. I do really care about children though and want to help them. I’m not sure if my demeanor is quite right for it though.
- Procedures are ok but not something I would need to do
- I think I’d enjoy being a consultant more than someone who refers out
- I don’t think I’d want surgery at all

Also board scores are a consideration. I’m a DO with 210-215 and 500-515 on boards so not every door is wide open.

Thanks for reading and I’d love some honest input!

---

Members don't see this ad.

 

[libertyyne]

PMR?
Psych?

It seems like you dislike a whole lot more than you like. What do you enjoy doing?

 

[deleted407021]

PMR?
Psych?

It seems like you dislike a whole lot more than you like. What do you enjoy doing?

I agree and that’s somewhat worrying.

I really enjoy talking to and listening to pateints. In fact one of the things I like about psych is that you get to spend so much more time than in other settings getting to know your patients. I enjoy seeing patients improve. I really like being part of the team as well.

Something I really love is educating people on health issues and just basic science communication. Probably the best part of primary care is explaining to patients different disease processes etc in clear and understandable terms.

 

[libertyyne]

I agree and that’s somewhat worrying.

I really enjoy talking to and listening to pateints. In fact one of the things I like about psych is that you get to spend so much more time than in other settings getting to know your patients. I enjoy seeing patients improve. I really like being part of the team as well.

Psych,
PMR
ID

 

[676188]

What about psych specializing in teens/adolescents? They don't require the happy/jolly the way little kids do. They appreciate quick wit, dry humor, and they can see right through you.

disclaimer: I am a pre-med student...I know nothing about specialties or residencies. I am an expert on children and teens though.

 

[lagbydesign]

Maybe consult psych? You work as part of a team, the pace is similar to surgery/EM, you can still take an hour to talk to your pts if necessary.

Ep 037 – Psychiatry with Dr. Jeanne Lackamp

 

[deleted407021]

What about peds --> neonatology? Get to do kids instead of adults minus the whole warm/jolly thing if you feel like you can tolerate the more serious cases, some procedures occasionally, you'd get to see a lot of (most? depending on the acuity of the NICU you work in I guess) your patients improve and go home healthier babies, work very closely as a team with the NICU nurses, peds surgery, etc., and get to do some education/explaining with the parents. Unfortunately the patients will still be non-verbal and self-soiling though...

Fully age appropriate however. Lol thanks for the post! Not a lot of psychology involved there but it’s an interesting area to look into. I’ve been curious about it.

 

[deleted407021]

Maybe consult psych? You work as part of a team, the pace is similar to surgery/EM, you can still take an hour to talk to your pts if necessary.

Ep 037 – Psychiatry with Dr. Jeanne Lackamp

Thanks for the link!

 

[Aerus]

You're not going to love every aspect of any specialty. It's all about compromising on the things you dislike for the things you like.

Seems like some subspecialty of Psychiatry is your thing. You can definitely utilize your Psychology background in Psychiatry, since we need more clinicians who pay attention to the psycho-social aspects of a patient's care rather than just focus on the basic, clinical, and pharmacological science.

 

[Detective SnowBucket]

Any interest in EM? Good balance of medicine and procedures.

 

[Roxas]

Neurology/Child Neuro? Seems to fit with your wanting to be a consultant, educating patients on their disease process, and maybe some procedures but nothing crazy. And where I was for neuro, clinic appointments were 30 min so you got to spend a decent amount of time with your patients.

imo neuro is a very underrated specialty

 

[MerYangBey]

Have you done your psych rotation? Or just saw psych in primary care setting?

 

[evilbooyaa]

Child/adolescent psychiatry would be my main thought for you. Consultant role, have a big role in managing ADD/ADHD and other psych issues in young children/tweens/teenagers. Pretty serious demand as well from what I remember in my psychiatry rotation. Most adolescent psychiatry patients aren't going to be catatonic.

Even if you want to peds, you don't have to be 100% "awwwww look at the babbbbbbby" all the time. You're their doctor, not their neighbor.

 

[deleted407021]

Have you done your psych rotation? Or just saw psych in primary care setting?

Psych in primary care. And that’s definitely a good point.

 

[MerYangBey]

Psych in primary care. And that’s definitely a good point.

I’m just wrapping up my psych rotation and there is a huge difference between inpatient psych, outpatient psych, and the psych I saw in primary care.
I feel like psych is one of those rotations that varies wildly by location/setting.

However I feel like after finishing your rotation you’ll have a good idea whether you can actually see yourself being a psychiatrist.

 

[deleted407021]

You're not going to love every aspect of any specialty. It's all about compromising on the things you dislike for the things you like.

Seems like some subspecialty of Psychiatry is your thing. You can definitely utilize your Psychology background in Psychiatry, since we need more clinicians who pay attention to the psycho-social aspects of a patient's care rather than just focus on the basic, clinical, and pharmacological science.

Great point. Thank you

 

[thegreengreatdragon]

Just my two cents: you don't need to be "warm/jolly" with kids all the time, as evilbooyaa said. As long as you're empathetic, I think you'd be fine. I know that there's this sort of vision of what a pediatrician is supposed to look like, but if you genuinely care about their health (which you said you do) and are not a giant jerk to them, I think you'd be fine.
Also, I think that as you work with kids, you'll find an attitude/approach that works for both them and you, so I feel like you shouldn't give up peds yet.
(I do also agree with everyone else about psych seeming like a good option for you)

 

[Keladry]

Sounds like child psych would be a great fit - definitely don't need to be overly "warm/jolly," need to be able to connect with them and show them you're listening.

 

[AnatomyGrey12]

Kids are way more interesting than adults and I loved my peds rotation but I don’t find them cute and I don’t think I can keep the warm and jolly thing going very long. I do really care about children though and want to help them. I’m not sure if my demeanor is quite right for it though.

I think I’d enjoy being a consultant more than someone who refers out

Between the bolded and the rest of the quoted posts I personally think peds--> subspecialty sounds like a good fit.

Child psych also seems like something to consider.

 

[Oso]

I hated everything except peds ...

So now I'm doing peds. Tons of different subspecialties and career paths. You don't have to be all jolly and cutesy all the time. Don't expect to make the big bucks though

 

[sloop]

However, I’m not sure how much I will like the field in practice. A few of the mentally ill patients I’ve encountered in my primary care rotations have been interesting but one case was less fascinating and more unsettling. I didn’t want to spend any more time with this non-verbal, self-soiling patient than I needed to and it occurred to me that a case like that could be bread and butter for psych in many settings.

The type of patient you mentioned is not bread and butter. It’s not terribly uncommon in an inpatient setting but it is definitely a minority. Most people in psych find these types of cases to be some of the most difficult. I think you’d be in good company.

The thing with psych is that you’re there to help all sorts of people with various functional impairments and some of that is going to be extremely sad or frustrating. Part of the beauty of this line of work is that even with the really tough cases, people deserve to be treated with kindness and respect. You have to be kind and humane to people even when they’re angry or aggressive due to an illness (people who are simply behaviorally abusive or antisocial are different—you shouldn’t tolerate that).

That said, your day won’t be filled with the completely dependent, intellectually disabled people unless you want it to be.

 

[deleted407021]

Thank y’all for all the great responses! Lots of great points all around and I’m feeling more encouraged as well.

The type of patient you mentioned is not bread and butter. It’s not terribly uncommon in an inpatient setting but it is definitely a minority. Most people in psych find these types of cases to be some of the most difficult. I think you’d be in good company.

The thing with psych is that you’re there to help all sorts of people with various functional impairments and some of that is going to be extremely sad or frustrating. Part of the beauty of this line of work is that even with the really tough cases, people deserve to be treated with kindness and respect. You have to be kind and humane to people even when they’re angry or aggressive due to an illness (people who are simply behaviorally abusive or antisocial are different—you shouldn’t tolerate that).

That said, your day won’t be filled with the completely dependent, intellectually disabled people unless you want it to be.

Thank you, that’s good to hear. I sometimes find myself being the only one in discussing a patient standing up for them due to their social or psychological circumstances. I always try to keep that in mind.

 

[deleted407021]

I hated everything except peds ...

So now I'm doing peds. Tons of different subspecialties and career paths. You don't have to be all jolly and cutesy all the time. Don't expect to make the big bucks though

Sounds like child psych would be a great fit - definitely don't need to be overly "warm/jolly," need to be able to connect with them and show them you're listening.

Great! Not having to be Ms. Frizzle 24/7 is a relief.
I feel like showing them you're listening is very important, as well as showing them respect, especially with adolescents

 

[BigRedBeta]

I don't think you should ignore that you liked peds better than adult medicine.

There are plenty of us in the higher acuity sections of peds that are not considered very cuddly. In fact, of the NICU/PICU/Cardiology people I know (which is a lot as a PICU attending), I would only characterize about 5% of us as "Ms. Frizzle", with a great many of us quite willing and able to go toe to toe with any surgeon who doesn't seem to get the picture of what's happening.

Now that said, you will have to spend 3 years in residency with people who clearly should have either been pediatricians or kindergarten teachers.

 

[deleted407021]

I don't think you should ignore that you liked peds better than adult medicine.

There are plenty of us in the higher acuity sections of peds that are not considered very cuddly. In fact, of the NICU/PICU/Cardiology people I know (which is a lot as a PICU attending), I would only characterize about 5% of us as "Ms. Frizzle", with a great many of us quite willing and able to go toe to toe with any surgeon who doesn't seem to get the picture of what's happening.

Now that said, you will have to spend 3 years in residency with people who clearly should have either been pediatricians or kindergarten teachers.

My peds attending (one of my favorite human beings ever) told me their alternative career would have been kindergarten teacher and I was like

Another helpful post, thanks!

 

[Groy]

I have a feeling doing your actual psych rotation will answer alot of questions for you! Otherwise I'd agree with above posters who mentioned Peds Neuro.

 

[NotYou20]

Psych still sounds like your best bet. You're worried about a type of patient I haven't seen at all in my inpatient month. If you do outpatient you can avoid it entirely after residency. It really seems like too minor of an issue to deter you. Definitely consider child psych.

 

[mvenus929]

I think you need to do your psych rotation to make your decision, honestly. As with most things, primary care sees the broad range of things, but the specialty (psych in this case) sees the distilled version.

Several Peds subspecialties would also be a good fit based on what you’re saying. GI and Adolescent are being on psych diagnoses. PICU and NICU are very to the point and focused on managing the acute problem (PICU moreso, since the babies in the NICU could stay for months). Any specialty where you’re dealing with chronic illness (cards, nephrology, Endo, heme/onc, pulm) is going to have some coaching and helping patients deal with their disease and hopefully go on to live healthy lives.

Palliative Care might be something to consider too, if you feel that you have the demeanor for it.

 

[libertyyne]

The only reason I didnt think Peds, especially subspecialties was a good fit was based on the bolded

Hey y’all, long post incoming.

3 rotations into third year and it’s about time for a weird crisis of identity and slowly brewing panic about which specialty I want to go into and how to prepare. Obviously I don’t tolerate long term uncertainty very well.

I’ve always been interested in psych. I majored in psychology in undergrad and the mental and social elements of wellness along with all the theories are things I can geek out about endlessly. I’m really fascinated by it. However, I’m not sure how much I will like the field in practice. A few of the mentally ill patients I’ve encountered in my primary care rotations have been interesting but one case was less fascinating and more unsettling. I didn’t want to spend any more time with this non-verbal, self-soiling patient than I needed to and it occurred to me that a case like that could be bread and butter for psych in many settings. I have a good amount of personal experience of how mental illness can affect people within my family and I would loving having a part of people living happier more rewarding lives. So I’m unsure.

Some things I’ve learned:
- I don’t like primary care. It feels like managing decay.
- I don’t like adult medicine. Vaguely numb feet and playing with numbers and telling people for the 500th time to stop X unhealthy behavior is not compelling
- A lot of basic medicine isn’t compelling work. Memorizing lab value ranges and guidelines and adjusting meds based on small number changes gives me a headache.
- Kids are way more interesting than adults and I loved my peds rotation but I don’t find them cute and I don’t think I can keep the warm and jolly thing going very long. I do really care about children though and want to help them. I’m not sure if my demeanor is quite right for it though.
- Procedures are ok but not something I would need to do
- I think I’d enjoy being a consultant more than someone who refers out
- I don’t think I’d want surgery at all

Also board scores are a consideration. I’m a DO with 210-215 and 500-515 on boards so not every door is wide open.

Thanks for reading and I’d love some honest input!

 

[raiderette]

I was a a psych major in college, so thought about psych and neuro. My vote would be for child neuro.

 

[WedgeDawg]

• Adolescent psych (as was already mentioned)
• Pediatric emergency medicine (either through the peds --> EM fellowship or EM--> peds fellowship routes)
• PM&R ("managing decay" but a lot of people get better and you get to talk to people a lot, or you could go the sports med route; there are a TON of subspecialties)
• Adolescent medicine (through peds, I think was mentioned before)
• Pediatric neurology (peds but a totally different population than general peds as patients are often very neurologically delayed and you still get to talk to them and their families but don't necessarily need that jolly demeanor, especially because things can be serious or sad pretty frequently) (if you're interested, keep in mind this is its own residency and not a fellowship after neurology)
• Anesthesia --> peds anesthesia
• Sports medicine (many specialities, healthy patients but most likely through FM, peds, or EM)
• Peds --> NICU (was already mentioned too)

I think peds neuro, peds anesthesia, adolescent med, or peds ED would be the best things to look into. I think all are easily attainable for DOs in your score range

 

[Esotsm7]

- I think I’d enjoy being a consultant more than someone who refers out

In addition to the specialties discussed above, have you thought about path?

 

[bananafish94]

Some of your points resonated with me and I'm strongly considering neonatology. It also sounds like you would do well in child psychiatry.

 

[Black Coffee 24/7]

Hey y’all, long post incoming.

3 rotations into third year and it’s about time for a weird crisis of identity and slowly brewing panic about which specialty I want to go into and how to prepare. Obviously I don’t tolerate long term uncertainty very well.

I’ve always been interested in psych. I majored in psychology in undergrad and the mental and social elements of wellness along with all the theories are things I can geek out about endlessly. I’m really fascinated by it. However, I’m not sure how much I will like the field in practice. A few of the mentally ill patients I’ve encountered in my primary care rotations have been interesting but one case was less fascinating and more unsettling. I didn’t want to spend any more time with this non-verbal, self-soiling patient than I needed to and it occurred to me that a case like that could be bread and butter for psych in many settings. I have a good amount of personal experience of how mental illness can affect people within my family and I would loving having a part of people living happier more rewarding lives. So I’m unsure.

Some things I’ve learned:
- I don’t like primary care. It feels like managing decay.
- I don’t like adult medicine. Vaguely numb feet and playing with numbers and telling people for the 500th time to stop X unhealthy behavior is not compelling
- A lot of basic medicine isn’t compelling work. Memorizing lab value ranges and guidelines and adjusting meds based on small number changes gives me a headache.
- Kids are way more interesting than adults and I loved my peds rotation but I don’t find them cute and I don’t think I can keep the warm and jolly thing going very long. I do really care about children though and want to help them. I’m not sure if my demeanor is quite right for it though.
- Procedures are ok but not something I would need to do
- I think I’d enjoy being a consultant more than someone who refers out
- I don’t think I’d want surgery at all

Also board scores are a consideration. I’m a DO with 210-215 and 500-515 on boards so not every door is wide open.

Thanks for reading and I’d love some honest input!

These qualities describe the Neontology people that I have the opportunity to work with to the T's.

All of them are great, very smart, and super nice. I think you would fit in well.

Try to get an Neontology elective and see how you would fit in.

 

[deleted407021]

In addition to the specialties discussed above, have you thought about path?

It was by far one of my least liked courses in preclinicals and I still definitely want to spend time with patients. I think I just need to find the right population

 

[kazill]

Could be worth considering medical genetics.

 

[deleted407021]

It just struck me that, even in neonatology, my strong interest in and aptitude for psychology would be invaluable in building rapport with and understanding the kids’ families. Also, there appear to be some advanced training programs for physicians to earn credentialing in counseling, which is very interesting.