Dilema: struggle to do what you enjoy or take the sure way out

[DrDude]

I really enjoy general surgery. But my stats may not be good enough to get a categorical general surg residency out of med school. If I decide to go ahead with it I may have to do preliminary surgery for 1-2 years with no guarantee that I'll be able to get a categorical position.

I can tolerate family med or internal med. By that I mean I don't enjoy it as much as surgery but I could still do it if need be. My stats are good enough that I can match into one of these straight out of med school and be done with training in 3 years.

What to do? Do I take the gamble with what I enjoy (general surg) or go for the more sure thing (internal or family med) and be done in 3 years?

Now I know I may match into categorical general surgery, but let's just say for the sake of arguement the above scenario are my options.

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[Nikiforos]

Go with what you enjoy more (or think that you will enjoy more), i.e. surgery. Otherwise, you'll always wonder, "what if?" Surgery is harder to match than family med. Therefore, it will probably be easier to move to FP from surgery rather than the other way around if you should decide to do that later.

 

[WallowaWanderer]

If you are truly passionate about surgery I think you have to go for it. Do everything you can to bolster you CV, crush step II early, get great letters, apply everywhere, and go to as many interviews as you can stomach. I bet you still have a shot. People do tend to drop out of surgery programs, so a prelim year probably isn't a bad backup option.

 

[Winged Scapula]

If you don't at least try, you'll always wonder if you made the right choice. I spent a number of years doing something I enjoyed, but it wasn't really what I wanted to do, so made the decision to return to medical school.

And if you don't match into surgery (make sure you give yourself a time frame Plan at which you will pack it in and try for something else) bear in mind that there are FP programs, although fairly competitive, which do train residents in some basic surgerys (ie, appys, hernias, etc.) which may be of interest to you.

 

[barcalounger]

What to do? Do I take the gamble with what I enjoy (general surg) or go for the more sure thing (internal or family med) and be done in 3 years?

If you are sure you will like general surgery, then go for it.

 

[HCE]

If you are sure you will like general surgery, then go for it.

I totally agree with the other posters. Go for what you enjoy. You may also want to do a few clinical rotations at places where you may want to apply. This can help or hurt your chances of matching at one of those places, so work your tail off.

 

[Geri_Gal]

Go for what you enjoy.

If you do not match into cat gen surg, then you'll likely match into one of the numerous prelim spots. Ideally, you'd show that institution how motivated you are and match there (or elsewhere) in gen surg.

Life is too short and you will only do yourself AND your patients a disservice by matching into FM or IM if you truly don't enjoy those fields (you will likely not be motivated to read about the latest HTN, hyperlipidemia management, you will miss that esoteric rheumatologic diagnosis, etc...) In short: your patient care is likely to suffer for it.

 

[buckley]

If you don't at least try, you'll always wonder if you made the right choice.

I agree...

 

[secretwave101]

One of our faculty attendings started in surgery, then decided FM was more his thing and he hasn't looked back. He still practices a more surgically-oriented style of FP.

Go for Sx. FM/IM will always be there if you wash out or decide it isn't for you.

 

[AmoryBlaine]

The underlying issue is that FM is "easier" than Surg. This is almost certainly true in terms of hours and physical demand of the specialty.

The problem for the OP is that if you do a specialty you're not really into it's never going to be easier. If you really see yourself in a practice that includes the OR, you might become a little frustrated 15 years down the road as you head in to a 30 patient day of HTN, DM, shots, and sports physicals.

 

[Faebinder]

Take IM/FM.... forget the trying. There is life outside the hospital and you wont realize it till you start residency and you are always in the hospital.

If you want to be a surgeon, you have to love being in the hospital more than being at home. That's the attitude that is respected between surgeons.

 

[mlw03]

i agree with faebinder, although for different reasons. i think prelim surg spots are the biggest sucker's wager in all of medicine. think about it: you work 80 hours a week for very demanding surgeons, mostly doing floor scut work and gaining very little actual surgical skill because if any pgy-1 is gonna get in the ORs, it's gonna be the categoricals, not you. at the end of the year, if you're super lucky and kiss just the right spot on the butt cheeks, you get to do it again next year. if not, "thanks and good luck, and don't let the door hit your *** on the way out." sure, some people make it through, but what happens to those who don't? no other specialty still has this archaid pyramid type of system, and as long as people try to "reach for their dreams" by accepting this horrible offer, it'll continue. do FM, then pursue an OB or emergency fellowship - you'll get plenty of hands on stuff, but most importantly, you'll be guaranteed a complete residency to board eligibility. you owe yourself that after 4 years of medical school.

 

[Faebinder]

i agree with faebinder, although for different reasons. i think prelim surg spots are the biggest sucker's wager in all of medicine. think about it: you work 80 hours a week for very demanding surgeons, mostly doing floor scut work and gaining very little actual surgical skill because if any pgy-1 is gonna get in the ORs, it's gonna be the categoricals, not you. at the end of the year, if you're super lucky and kiss just the right spot on the butt cheeks, you get to do it again next year. if not, "thanks and good luck, and don't let the door hit your *** on the way out." sure, some people make it through, but what happens to those who don't? no other specialty still has this archaid pyramid type of system, and as long as people try to "reach for their dreams" by accepting this horrible offer, it'll continue. do FM, then pursue an OB or emergency fellowship - you'll get plenty of hands on stuff, but most importantly, you'll be guaranteed a complete residency to board eligibility. you owe yourself that after 4 years of medical school.

 

[scala]

My experience this year has taught me that you will be most competitive in the field that you enjoy the most. It will just shine through in your recommendations, interviews, activities, ect.

You have to be well suited for the specialty. If you think you will be happy with surgery you have to go for it.

 

[Tiki]

Apply for both. There is nothing stopping you from applying for general surg and a few family practice programs next year as backup. There were several students in my class whose first choice was a competitive field where they knew they might not match so they applied to a few extra programs in a less competitive specialty.

There are two possible problems with this though:

1. It is said that you shouldn't apply to both specialties at the same program, so if you are geographically restricted, the double applying probably won't work for you.

2. Applying to two fields is double the work: you need two personal statements, you have to spend twice the amount of money on applications/interviewing. Not to mention you have to seem enthusiastic about your second choice specialty. Although if you choose to go into FM or IM instead of surgery, you are going to have this problem anyway.

 

[Winged Scapula]

i agree with faebinder, although for different reasons. i think prelim surg spots are the biggest sucker's wager in all of medicine. think about it: you work 80 hours a week for very demanding surgeons, mostly doing floor scut work and gaining very little actual surgical skill because if any pgy-1 is gonna get in the ORs, it's gonna be the categoricals, not you

This may have been the case at the hospitals you have been affiliated with, but it is far from a universal truth. There are many places, both in my experience, my friends and from comments on SDN, where the Prelims get the same rotations and same cases as do the Categoricals. The only time I can recall Prelims not getting cases was when the IM/EM/Peds residents rotated on surgery and this was only because the vast majority of them did not want to be in the OR. So the OP should not assume that being a Prelim means he will be doing mostly floor work and no OR...its all dependent on the program.

That said, being a non-designated Prelim is hard work, essentially a year long audition.

sure, some people make it through, but what happens to those who don't? no other specialty still has this archaid pyramid type of system, and as long as people try to "reach for their dreams" by accepting this horrible offer, it'll continue.

Obviously its not a pyramidal system where residents are hired assuming they will finish. A Prelim is hired for a year, no guarantees for anything more than that. And a surgical Prelim year is no different than someone doing an IM Prelim or TY before an Advanced match - they still are not guaranteed to have a position the following year. While I feel bad for those locked in, its "caveat emptor", those who accept this "horrible offer" have to understand the risks they are taking.

do FM, then pursue an OB or emergency fellowship - you'll get plenty of hands on stuff, but most importantly, you'll be guaranteed a complete residency to board eligibility. you owe yourself that after 4 years of medical school.

The OP hasn't even applied yet. Are you suggesting that he not even try and match into surgery but rather go ahead and accept what is clearly his second choice without even trying? I would venture that its better advice to:

1) try and match into categorical surgery
2) failing 1), then try and get a Prelim spot
3) if after successfully completed a Prelim year (or two) he fails to get a Categorical position, THEN he should consider applying to another field.

What the loss? A couple of years (at the most), some time, etc. IMHO its better to at least try and obtain your dreams rather than give them up on the assumption you won't achieve them.

 

[secretwave101]

Rotated surg at Cottage Hospital in Santa Barbara - no designation whatsoever between prelims and categoricals in terms of OR time and cases.

 

[Samoa]

Most people think my chosen specialty is unbearably hard, but it never seems that way to me. I find it SO much harder to work in other specialties, regardless of how easy or hard they are to match into.

Medicine is hard enough when you love what you do. I don't think it's worth the sacrifice in a specialty where you don't.

 

[Finding Chi]

I agree with the majority of posters... do what you actually like. We all work crappy hours and suffer abuse from a wide range of people as interns and residents. If you don't like what you do, why on earth would you put up with it?

Even if it's "easier," it may still drive you nuts (Case in point, rotated through a month of derm clinics... by the end I thought I might kill myself if I had to freeze off another wart).

General surgery can be competitive, but it's not at the level of derm or ENT. Cast a wide net, apply to lots of programs, maybe do some away rotations. You may do better than you think.

 

[Faebinder]

We had this discussion in another thread. Someone posted how 80% of the surgery prelim don't go to catagorical. There are many prelim surgeons out there who didnt go catagorical till after 3 prelim years.

The odds are against the OP. So it comes back to what I said... does he/she love the hospital more than home. Take it from there.