Do the people in your desired specialty play a part in choosing?

[Calizboosted76]

This may be a superficial post, but as I go through my clinicals I notice that each field has a different group of people overall. I know that there are outliers but I was just curious if you were drawn to or turned away from a certain specialty due to the colleagues you would end up having to deal with.

I know jocks are drawn to ortho, "nerds" are drawn to nephro or neuro (I say that with quotations because were all nerdy).

As I kind of focus on a specialty this is something I was curious. I initially thought I wanted to do surgery but a mentor told me that my family time and quality of life may be better doing IM to a subspecialty. I still have plenty of time but I would like to get the forums thoughts because you have all been a huge part of my premed to med student years.

As always,
Thank you in advance.

---

Members don't see this ad.

 

[Drrrrrr. Celty]

I guess? Most people in medicine are nerdy as a whole. That being said there are plenty of medicine residents who literally have about as much passion for pathophysiology as moss crawling over a rock.

I think there's a wide distribution of personalities in each specialty. That being said that distribution changes enormously based on what type of residency program you're in and also where. Self selection influences things greatly. An IM program with an average STEP 1 of 250 is going to have a lot of extremely hard working, brilliant, motivated, and deeply interested in the future of medicine types. An IM program with an average COMLEX of 450 is going to predominantly have a bunch of people looking towards getting a job and being generally normal human beings.

I suppose moving to the second half of your post. Surgery is going to be hard. A lot of surgeons are busy even after residency. The average IM subspecialist in something like Endo, Rheum, or even Hem/onc is going to work banker hours and be home for dinner most evenings.

That being said it's about finding what you like to do and do well enough to make you happy and satisfy you.

 

[Calizboosted76]

I appreciate the response!

A few of the doctors on the wards this past rotation said that you "find your people and where you belong" so I was kind of curious if anyone else had these experiences. I feel like I get along with surgeons, EM doctors, and Crit care doctors. However I feel like I can get along with anyone.

Yea Oncology is on my radar. I need determine if I want to be in a specialty that is procedural or if I would be okay managing cancer patients.

I do think I am thinking more along the lines of IM when factoring in my family and lifestyle. However I do enjoy being on the wards and the other day we had a few patients that we had to run to their rooms for a MED call and I got very excited to be able to help in an emergent situation.

 

[Ho0v-man]

I kinda see it like this. You start exploring the specialty because of some initial interest. That could be the pathology/physiology, the role you would play in care such as performing procedures or managing vents. Even lifestyle and pay can be that thing that sparks initial interest.

Then you rotate through and end up finding people who are similar to you. You think auto-immune lambic encephalitis is cool? Well on your neuro rotation you’ll be in a room full of people ready to tell you way more than you ever thought possible to know about it and you start thinking “I want that to be me!” When you go home after a long day and start studying, do you find it interesting or are you just trying to slog through the shelf?

It goes both ways though. Maybe you realize that you could never be that into neurology coming off crushing stroke call. so then maybe you start thinking “that can’t be me!” I see this a lot in FM residents who really like things like OBGYN. They’ll talk your ear off about it but also acknowledge they could never do it all day every day.

 

[Drrrrrr. Celty]

I think that's also an important factor. The I'm good at this, but I can't do this long term because it'll kill me.

I loved loved loved critical care. Being in the ICU was amazing and fun for me.

That being said after a week of taking care of people with 10% lung, heart, and possibly brain function I get burnt out because I feel like it's futile care. Furthermore the amount of unpredictable work and the chaos that comes with working with others brings me a lot of dissatisfaction when the interactions or quality of work begins to crap out. Nothing like admitting medical errors to the ICU on fridays or saturdays.

Likewise in the ICU you'll honestly see a lot of the darkness in life. You'll see a lot of grateful people, but a lot of truly evil folks.

It's not who you work with that matters in your field. What you really need to consider and choose is a field that meets the stands and conditions of your employment. Ex. Clinic, ambulatory patients, sick v.s not sick.

 

[Calizboosted76]

I kinda see it like this. You start exploring the specialty because of some initial interest. That could be the pathology/physiology, the role you would play in care such as performing procedures or managing vents. Even lifestyle and pay can be that thing that sparks initial interest.

Then you rotate through and end up finding people who are similar to you. You think auto-immune lambic encephalitis is cool? Well on your neuro rotation you’ll be in a room full of people ready to tell you way more than you ever thought possible to know about it and you start thinking “I want that to be me!” When you go home after a long day and start studying, do you find it interesting or are you just trying to slog through the shelf?

It goes both ways though. Maybe you realize that you could never be that into neurology coming off crushing stroke call. so then maybe you start thinking “that can’t be me!” I see this a lot in FM residents who really like things like OBGYN. They’ll talk your ear off about it but also acknowledge they could never do it all day every day.

Yea that makes sense. I more so was curious if people are able to find colleagues that they are able to connect with or if it was a certain "type" people that you connected with.

Like with me, if you interacted with me or seen me in real life you would think I am going Ortho, no doubt about it. But I would never do ortho.

However I find that I have enjoyed:

- Oncology because I can resonate with the families and patients and having a solid Onc doc can drastically impact patients. The lack of procedures that are potential have me a little iffy.

- Inpatient IM because of the patient interactions and how my preceptor made everyone on the team know they were important plus the round and go gigs are pretty cushiony. I just dont like the feeling of not being a specialist in a field, I want to be the best at whatever it is I choose to do.

- Crit care due to the high acuity of patients. I am also very good at dealing with the bad. I can compartmentalize and dissociate from that kind of stuff very well.

- Surgery I like having a problem I can most of the time fix immediately. The only issue I am battling with this is the family life. I have a kid and I know I will be absent for some things but from what I have heard is that I will basically miss out on everything even during the attending life. As of right now Im like " I can manage this and be there for what I can and they will understand" on the other hand Im like, is being able to become a surgeon worth them having to understand that daddy is gone because he chose this specialty.

- Neuro I love the brain and some of the pathophys, however the patient population and the disease processes from what Ive seen and read are kind of draining in the sense that there isnt much that can be done to "cure" some of them and you basically just watch long term patients dwindle. I know youre probably thinking "Well you just said you can compartmentalize and blah blah blah", yes I can and I could with neuro as well however the acuity of crit care out weighs that for me.

- IR The doc was super cool and was willing to let me come onto his service and watch a few different procedures. Seemed like a solid gig, however I dont know that I would be okay being in DR if I couldnt match to IR.


I find a lot of content fascinating so its hard to narrow down as of now. So basically I was just curious if the people in the feild were a draw towards a certain feild. Like I should be drawn to ortho because those are some of my people but I am not.

 

[Calizboosted76]

I think that's also an important factor. The I'm good at this, but I can't do this long term because it'll kill me.

I loved loved loved critical care. Being in the ICU was amazing and fun for me.

That being said after a week of taking care of people with 10% lung, heart, and possibly brain function I get burnt out because I feel like it's futile care. Furthermore the amount of unpredictable work and the chaos that comes with working with others brings me a lot of dissatisfaction when the interactions or quality of work begins to crap out. Nothing like admitting medical errors to the ICU on fridays or saturdays.

Likewise in the ICU you'll honestly see a lot of the darkness in life. You'll see a lot of grateful people, but a lot of truly evil folks.

It's not who you work with that matters in your field. What you really need to consider and choose is a field that meets the stands and conditions of your employment. Ex. Clinic, ambulatory patients, sick v.s not sick.

That makes a lot of sense as well. I am not going to choose a field just due to the people in it. I was just curious if anyone had ever been drawn to a field because the people in it are "your type of people" or if they just found their people in the field.

 

[Calizboosted76]

Something I struggle with is wanting to do everything. I think my eyes are too wide at the moment.

 

[Ho0v-man]

Yea that makes sense. I more so was curious if people are able to find colleagues that they are able to connect with or if it was a certain "type" people that you connected with.

Like with me, if you interacted with me or seen me in real life you would think I am going Ortho, no doubt about it. But I would never do ortho.

However I find that I have enjoyed:

- Oncology because I can resonate with the families and patients and having a solid Onc doc can drastically impact patients. The lack of procedures that are potential have me a little iffy.

- Inpatient IM because of the patient interactions and how my preceptor made everyone on the team know they were important plus the round and go gigs are pretty cushiony. I just dont like the feeling of not being a specialist in a field, I want to be the best at whatever it is I choose to do.

- Crit care due to the high acuity of patients. I am also very good at dealing with the bad. I can compartmentalize and dissociate from that kind of stuff very well.

- Surgery I like having a problem I can most of the time fix immediately. The only issue I am battling with this is the family life. I have a kid and I know I will be absent for some things but from what I have heard is that I will basically miss out on everything even during the attending life. As of right now Im like " I can manage this and be there for what I can and they will understand" on the other hand Im like, is being able to become a surgeon worth them having to understand that daddy is gone because he chose this specialty.

- Neuro I love the brain and some of the pathophys, however the patient population and the disease processes from what Ive seen and read are kind of draining in the sense that there isnt much that can be done to "cure" some of them and you basically just watch long term patients dwindle. I know youre probably thinking "Well you just said you can compartmentalize and blah blah blah", yes I can and I could with neuro as well however the acuity of crit care out weighs that for me.

- IR The doc was super cool and was willing to let me come onto his service and watch a few different procedures. Seemed like a solid gig, however I dont know that I would be okay being in DR if I couldnt match to IR.


I find a lot of content fascinating so its hard to narrow down as of now. So basically I was just curious if the people in the feild were a draw towards a certain feild. Like I should be drawn to ortho because those are some of my people but I am not.

As far as DR to IR, 100% of DR residents that want to do IR can get into IR. Worst case scenario is having to do a two year IR fellowship instead of ESIR from DR. Half of those go unfilled so literally anyone can get into IR.

From the family side of things, no matter what you pick there will be times when you are not as good of a partner or parent because you’re a doctor. A lot of people don’t realize this. Unless you have kids after being an attending and have a “mommy track” of gig, you will miss out on family as a doctor. You can’t have it all…

 

[Calizboosted76]

As far as DR to IR, 100% of DR residents that want to do IR can get into IR. Worst case scenario is having to do a two year IR fellowship instead of ESIR from DR. Half of those go unfilled so literally anyone can get into IR.

From the family side of things, no matter what you pick there will be times when you are not as good of a partner or parent because you’re a doctor. A lot of people don’t realize this. Unless you have kids after being an attending and have a “mommy track” of gig, you will miss out on family as a doctor. You can’t have it all…

No, Im aware of this for sure and I am okay with it. My daughter thinks that I am a superhero and she loves that I go "save people". My wife understands because we have been together since high-school and she knew that I wanted to do something that was going to be very demanding. She still remains on my side and okay with any sacrifices that must be made.

 

[Calizboosted76]

As far as DR to IR, 100% of DR residents that want to do IR can get into IR. Worst case scenario is having to do a two year IR fellowship instead of ESIR from DR. Half of those go unfilled so literally anyone can get into IR.

From the family side of things, no matter what you pick there will be times when you are not as good of a partner or parent because you’re a doctor. A lot of people don’t realize this. Unless you have kids after being an attending and have a “mommy track” of gig, you will miss out on family as a doctor. You can’t have it all…

I didnt know that IR was able to be had for sure. I thought it was like matching a fellowship and there was no guarantee in matching so to be ready to just practice DR.

 

[Captain_Falcon]

- Neuro I love the brain and some of the pathophys, however the patient population and the disease processes from what Ive seen and read are kind of draining in the sense that there isnt much that can be done to "cure" some of them and you basically just watch long term patients dwindle. I know youre probably thinking "Well you just said you can compartmentalize and blah blah blah", yes I can and I could with neuro as well however the acuity of crit care out weighs that for me.

Just pointing out that this isn't true for neurology anymore. The advancements that have been made across most subspecialties (ie neuroimmunology, migraine, etc) have been life-changing for patients. You are correct in that for neurology most diseases won't have a quote unquote cure, but that is literally for almost all of medicine (insert HF, COPD, cirrhosis, diabetes, CKD, rheumatological disorders, etc etc). Most of medicine is management of disease, often with disease-modifying drugs in today's world, thereby making the quality of life so much better than yesteryears.

Not directed at you specifically, but just so others reading this don't hear the old adage that neurology doesn't do anything for their patients

 

[Calizboosted76]

Just pointing out that this isn't true for neurology anymore. The advancements that have been made across most subspecialties (ie neuroimmunology, migraine, etc) have been life-changing for patients. You are correct in that for neurology most diseases won't have a quote unquote cure, but that is literally for almost all of medicine (insert HF, COPD, cirrhosis, diabetes, CKD, rheumatological disorders, etc etc). Most of medicine is management of disease, often with disease-modifying drugs in today's world, thereby making the quality of life so much better than yesteryears.

Not directed at you specifically, but just so others reading this don't hear the old adage that neurology doesn't do anything for their patients

Thank you for clarification. I’m interested in neurology for sure. You just helped it jump up a few spots by bringing this to light. Thank you!

 

[Calizboosted76]

Just pointing out that this isn't true for neurology anymore. The advancements that have been made across most subspecialties (ie neuroimmunology, migraine, etc) have been life-changing for patients. You are correct in that for neurology most diseases won't have a quote unquote cure, but that is literally for almost all of medicine (insert HF, COPD, cirrhosis, diabetes, CKD, rheumatological disorders, etc etc). Most of medicine is management of disease, often with disease-modifying drugs in today's world, thereby making the quality of life so much better than yesteryears.

Not directed at you specifically, but just so others reading this don't hear the old adage that neurology doesn't do anything for their patients

Could you speak to the competitiveness to interventional neurology?

 

[Captain_Falcon]

Could you speak to the competitiveness to interventional neurology?

Extremely. It’s the only neurology subspecialty that is competitive (you compete against neurosurgery and radiology residents for the right to remove LVOs)