Fourth year med student and completely lost

[nightowl]

Hoping for some advice here.

I am a fourth year med student. I have absolutely no clue, NOT A CLUE, what to do specialty wise. I'm in a unique predicament bc husband is already matched in a five year surgery program somewhere with not many other programs. We bought a house there, not much likelihood of him transferring. I wanted that location bc it's close to family so we would have help... thinking a few years from now we might try for a baby. Now I'm just confused and overwhelmed with what to do.

I enjoyed ob-gyn and surgery, but neither seemed to be suited for my personality and the hours really wore on me after a while. I didn't really mesh with the people on ob, to the point that I felt pretty miserable a good bit of the time. But I enjoyed the surgeries and the deliveries. That said, I didn't feel SOLD on it, the material wasn't that interesting to me, and I just don't necessarily feel like it would be a good decision to choose it. I really don't want the hours of the typical ob/gyn when I get out. I know people say it can be what you want to make it, but there are so many people miserable in the field that it makes me question that. I'm just not sold on it. but I enjoy women as patients. I don't know.

surgery was fun. the hours were long, and I even considered it for a while. people laughed and said I would be "the friendliest surgeon they had ever met". I had a master plan to do breast surgery, which I thought would be a pretty great fit, bc I love oncology and I really enjoy the OR. Plus there's some hand holding and follow up with breast onco, not something you get in every subspec of surgery. That said, it takes six years, and I'm a woman, and it would be all-consuming for all of those six years, and I'm not sure if I want to put off having a family and having time for other things until mid-thirties. Plus, my husband is in a fairly malignant, traditional, trauma heavy surgery program, and it's the only one in that city, with NO nearby programs. The program isn't a good fit for me- personality wise, I'm not sure if I could handle the yelling, intimidation, q3 call, etc. But if I didn't try to match at his program, we'd be separated for five years, and I'm not sure if that would be good..... plus, I worry about job availability if I tried to go for the breast surg track. Husband wants to do big career himself, we want to settle close to family, and if I can't get a job doing breast surg, I'm not going to want to take the call and work the 60+ hours of gen surgery. I guess maybe by then, things could be more flexible hours wise, but I'm not sure if the attitude on surgery is amenable to those changes.

which is when I wonder if ob/gyn would be a better route- surplus of jobs, maybe the atmosphere/hours will be more adaptable by the time I'm out of residency, still women's health... but I don't just LOVE it the way I see the ob-gyn 4th year applicants loving it....

I had had all of these doubts before, so I signed up for a peds wards month this month, and I am not enjoying it, unfortunately. I love, love the people, then attendings and residents are GREAT, I really prefer the personalities compared to surgery or ob/gyn. I would love to have them as colleagues, but I find the WORK ITSELF absolutely, mind-numbingly boring, and spend most of every day not enjoying rounding/floor work/monotony of the field, and don't enjoy doing pediatric medicine. I thought thinking kids were adorable and lovable would equal enjoying peds medicine. NOT so. So it's out, which is really sad, bc husband's city has a GREAT program. pretty much the ONLY great program in the entire city. the family med program sucks, they don't have ER or anesthesiology AT ALL. If I can't handle the boredom/monotony of peds, IM really isn't a feasible option....

so then I think- hell, if neither of those specialties seem to be a fit, maybe I should consider ER, anesthesiology. ER or anesthesiology might fit. flexibility plus plenty of jobs at the end of the road. some procedures, not the boredom of endless rounding. sadly though, no programs near husband so the trade off would be living 2-4 hours away, maybe further, for 3-4 years. Ugh. and I don't have TIME this year to do rotations in ER and anesthesiology this fall and still have time to get recs and apply this fall. I'm slightly below average so I can't really afford to not apply and be unsure for much longer....

so then I wonder if I should just do family medicine. home programs near husband that are solid (within 1.5 hours of his program), some women's health, great hours even in residency, and hell, it would just be EASY. which in my situation, EASY is looking more and more desirable. I'm not sure if I'm just SO overwhelmed by trying to do what's best for my marriage and me too, or what. I'm concerned that I'm going to be bored in family med, but actually thought the rotation in the community was light years better than inpatient medicine or peds. I really don't care for the wards/rounding. Doing fam med was relaxed, I liked the people...

I just have NO IDEA. any advice would be greatly appreciated.

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[Lonestar]

my advice: go with the easy route. Cush hours and less haggle. However, once you finish family medicine residency your stress level will increase in private practice. If your husband makes good money, then you can chill and make less money in family practice.

 

[beanbean]

Tough decisions. Sounds like EM or GAS would have been a decent plan, but with no programs near your husband that would be really tough. I think family medicine might be a great fit for you. Short residency and you mentioned the programs near your husband are good. You would still be able to do women's health and maybe include OB. However, family med includes a fair amount of peds and if you hate peds that might be an issue. I would recommend having a talk with some of the family med faculty at your school. Perhaps that will help clear your mind.

 

[dragonfly99]

tough situation.
Sorry that you didn't get more help in figuring this out a bit earlier in the year. I DON'T think it's necessarily totally too late to consider anesthesia or ER...you would need to really get it in gear and do a rotation ASAP...like September...in one of these. Maybe I'm wrong b/c I did medicine not ER or gas, but I thought you could still apply in October/November and still get your application in under the wire.

Family practice sounds like it might be an option. Although it gets maligned, I think in the end a lot of them end up doing the same jobs as intern med folks, and they have a cushier residency. Also, you might have the opportunity to do some of the OB and other procedures that you liked as a student. Also, depending on where you live, family docs, and even IM docs, often work in emergency rooms (either along with or instead of ER docs). There aren't really enough ER docs to staff all the ERs and won't be enough any time soon. I guess a lot of people shy away from fp because some primary care can get routine/boring, and also we feared that NP's and PA's might take over that area of practice, and then you ccan have some crazy patients in primary care who are just so drug seeking and needy. However, the field does offer flexibility, and there will likely be a lot of jobs when you get done. IM is like that too...not necessarily the most desirable residency but there are a LOT of jobs for general IM.

Another option might be for your husband to transfer to a different general surgery program...I know this is generally hard to do, but it seems like your needs/wishes for residency were not part of the equation when you all decided where he'd go for residency, and decided to buy a house also. Still, you are where you are and we all have choices to make in life.

One thing also to remember is that medical practice is NOT = to residency. Just because you don't like rounding forever and writing long notes doesn't mean that you could never be any type of pediatrician or internist...though it might make you miserable for at least half of your residency! Some peds and IM docs end up working in urgent care, or other fields that don't require extensive note writing. It also gets easier as you learn more, learn to use templates on the computer, etc. to write notes quicker. They just torture you as a trainee by making you write super-detailed notes but that is not necessarily how medicine in private practice is.

Finally, work is not everything, especially not for certain people. So just pick something, with the best info and values you have available, and go for it. It sounds like you can find something that you like,as you like more than one thing.

 

[peppy]

Yeah, I think doing FM with an emphasis on women's health makes a lot of sense. You will have a lot of flexibility then, and it sounds like you have some genuine interest in that sort of medicine. You also shouldn't underestimate how nice it can be to live near your spouse and family while in residency!

 

[mercaptovizadeh]

You can do IM with a women's health track.

Also, since you like procedures, consider IM/peds subspecialties.

Sounds like Ob/Gyn's a bad idea.

Do you prefer outpatient or inpatient work? It's strange that you enjoy outpatient clinic and surgery but not inpatient medicine or peds, which is sort of "in between" the two.

 

[maceo]

FP. its 3 years and its flexible. alternatively you can do IM and become a hospitalist which aint that hard of a job. I would shy on anesthesia since its fours years long, and i think the job market is tightening up significantly and its not as flexible as you think. Its early mornings.. til at least 4ish 5ish everyday. you can find a job with no call but still have to be there 6-630 am. which is pretty early