I am currently on my last rotation of third year and as the school year closes, I am having a difficult time trying to decide what specialty to pursue. I have it narrowed down to Psychiatry(90% chance of choosing), Internal Medicine(with ID fellowship), Family Medicine, and Pediatrics(seriously only considering the first two). I have an interest in Microbiology so the IM to ID route has always been on my mind. To be honest though, I have found third year to be far less enjoyable than the pre-clinical years and have realized that a medical career is mostly about managing patients, chasing lab values, writing redundant notes on patients, deciphering illegible handwriting, coordinating care, following algorithms, and doing a lot of essential mundane tasks rather than about clinching a diagnosis, thinking over things scientifically, or knowing pathophysiology to the extent that we learned it for the boards.
Although I like the subject matter of Medicine, the actual job requires doing a lot of tedious things and someone who is a fast worker but doesn't necessarily have the best foundation of basic sciences knowledge could outperform someone with great board scores at the typical routine day to day job of a physician. Note that I am not criticizing the status quo and I realize that these 'mundane' tasks are extremely important to delivering good patient care.
I liked my IM rotation but again it was mostly about efficiency, churning through patients quickly, getting consults, hunting down patient charts, coordinating with ancillary services, and issuing discharges. I also am not very keen on procedures and my time spent in the ICU showed me that IM residency would still require performing a considerable number of them. Even though I can remember minutiae from the pre-clinical years, it was hard for me to remember and keep tabs on every little thing affecting the 20+ ICU patients. It is offputting that in IM residency I will likely have to spend months in the ICU as well as Surgery on my off-service time. ID physicians(and many IM attendings in general) don't do any procedures so IM residency with its various procedures just seems like another hoop to jump through before I can get to my goal which would also be a poor financial decision(ID physicians make less than General IM).
I am considering FM because it is more outpatient, seems to require less procedures than IM, and also contends with a significant amount of Psychiatry(~20% of patients). I am considering Pediatrics because it is rare to have pediatric patients with 20+ medical problems, would still allow me to practice 'real' medicine, has fewer procedures, and could be an 'easier' route to an ID fellowship although I am neutral to working with kids.
Psychiatry has been vying as my first choice since even before I began medical school. I suppose one of my qualms with choosing it is that I would eventually forget my medicine. To be honest though, that doesn't really concern me so much as the nagging feeling I have of whether Psychiatrists(and psychotropics) truly help patients instead of being ineffectual, or at times even harmful towards patients. I am not trying to criticize Psychiatry so much as wanting to have these guilty concerns of thinking that if I pursue Psychiatry, my work will be meaningless/unhelpful assuaged. It also seems as if even if I wanted to practice Psychiatry the 'right' way, the manner in which mental health services are set in place does not really allow for anyone to work outside the system or the status-quo.
The following posts by skpsycho back in 2008(http://forums.studentdoctor.net/threads/psychiatry-a-good-career.500442/) really had me concerned because he seems like he was an insightful, intelligent, Psychiatry resident(he later quit) who saw serious issues with the way Psychiatry is practiced in the US. Also, no one truly wrote cogent arguments to counter his points. Please note that I am not trying to fan any flames or criticize Psychiatry but in fact only to have my doubts cleared up so I can choose Psychiatry with a clear conscience and much enthusiasm!
Although I like the subject matter of Medicine, the actual job requires doing a lot of tedious things and someone who is a fast worker but doesn't necessarily have the best foundation of basic sciences knowledge could outperform someone with great board scores at the typical routine day to day job of a physician. Note that I am not criticizing the status quo and I realize that these 'mundane' tasks are extremely important to delivering good patient care.
I liked my IM rotation but again it was mostly about efficiency, churning through patients quickly, getting consults, hunting down patient charts, coordinating with ancillary services, and issuing discharges. I also am not very keen on procedures and my time spent in the ICU showed me that IM residency would still require performing a considerable number of them. Even though I can remember minutiae from the pre-clinical years, it was hard for me to remember and keep tabs on every little thing affecting the 20+ ICU patients. It is offputting that in IM residency I will likely have to spend months in the ICU as well as Surgery on my off-service time. ID physicians(and many IM attendings in general) don't do any procedures so IM residency with its various procedures just seems like another hoop to jump through before I can get to my goal which would also be a poor financial decision(ID physicians make less than General IM).
I am considering FM because it is more outpatient, seems to require less procedures than IM, and also contends with a significant amount of Psychiatry(~20% of patients). I am considering Pediatrics because it is rare to have pediatric patients with 20+ medical problems, would still allow me to practice 'real' medicine, has fewer procedures, and could be an 'easier' route to an ID fellowship although I am neutral to working with kids.
Psychiatry has been vying as my first choice since even before I began medical school. I suppose one of my qualms with choosing it is that I would eventually forget my medicine. To be honest though, that doesn't really concern me so much as the nagging feeling I have of whether Psychiatrists(and psychotropics) truly help patients instead of being ineffectual, or at times even harmful towards patients. I am not trying to criticize Psychiatry so much as wanting to have these guilty concerns of thinking that if I pursue Psychiatry, my work will be meaningless/unhelpful assuaged. It also seems as if even if I wanted to practice Psychiatry the 'right' way, the manner in which mental health services are set in place does not really allow for anyone to work outside the system or the status-quo.
The following posts by skpsycho back in 2008(http://forums.studentdoctor.net/threads/psychiatry-a-good-career.500442/) really had me concerned because he seems like he was an insightful, intelligent, Psychiatry resident(he later quit) who saw serious issues with the way Psychiatry is practiced in the US. Also, no one truly wrote cogent arguments to counter his points. Please note that I am not trying to fan any flames or criticize Psychiatry but in fact only to have my doubts cleared up so I can choose Psychiatry with a clear conscience and much enthusiasm!
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