Frantic about what specialty to go into FM, psych, Neuro, IM???? Need advice

[Sswxqw]

Okay I'm a third year D.O. Canadian (need visa) with level 1 score of 428 (just passed) and 50-75th percentile class ranking and no usmle.

Long story short I wanted to do psych and Neuro in undergrad and still am very interested in these subjects, coming into medical school I was aiming for psychiatry. It just so happens my psychiatry rotation elective is my last elective of the year so I have not actually gotten a feel for how the day flows, what the work flow feels like. But by May we will have already submitted VSLO applications for away rotations and pretty much decided on which specialty we want to do so I can't wait until then.

Then comes family medicine, I really liked my FM rotations and felt I actually got to navigate the patients lives and identify problems in their personal lives/work around their personality and provide counseling for patients, history taking etc which is what I liked a lot about psychology and psychiatry in undergrad, I realize I don't need the psychiatry medicine management as much in my life but feels the focused and in-depth interviewing and focused treatment navigation parts I really do like. I was pretty swayed into the field of family medicine but during the rotations I could see myself possibly burnt out from the task jumping and vast amount of paperwork in family medicine, and perhaps the long hours of patient time (as an introvert I find tiring to be 'on' all the time). I'm saying that because I do value being in a focused "flow state" at least some of the time in my future career, does anyone have any input as to my observation that family med may not be very "flow" friendly or introvert burn out?

I have a background in neuroscience and find the subject very interesting, although it is tougher for me to work with the patients who are very disabled and very sick, however for outpatient clinic I really enjoy the flow of things and being able to do a neurology physical exam. I find myself in the flow state often and I tend to like how neurology thinks about problems, but I wonder if its because I'm more comfortable with the diseases and have better grasp of it than some other medical areas.

I'm now in IM and liked inpatient environment more than I thought I would, I really enjoy being in the internal medicine team and thinking and discussing about challenging medical problems with other physicians, the focused patient encounters are also nice (I would say I enjoy outpatient encounters more but also get worn out faster from the social interaction). I also really enjoyed gynecology in my OBGYN and could imagine doing something with gynecological procedures and counseling in the future.

I'm trying to decide on which field I should go into based on my interests and suitability but I'm very stuck and need some advice. I realize my scores are limiting but I would rather try for a reach field and apply to some backup places than not try at all, or right now, not being able to decide at all 🙁

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[DO2015CA]

I’m not quite sure what you meant about flow state. If I’m understanding it as you like the predictable clinic schedule with natural transition from one task to another then I think you actually like FM. As a medical student, FM can seem like a cluster because you are trying to sort through so much information but as you go through training that becomes easier for everything. Another thing with FM is you can tailor it as you like within reason. You can set a schedule and only allow certain cc from those designated time slots (ie. Well adult visits at the top of the hour and :30 with 2 acute visits at :15 and :45.) This will give you more predictability and less feeling like you are running all over the place.

 

[deleted1100659]

Do you want to be very procedural/hands on? Then probably not psych

Best chance at work/life balance? More than likely psych

Lowest burnout? Probably psych

Do you want to know a little bit of everything but not excel, so to speak, at a particular field? Probably FM

you need to soul search and be true to yourself. What gives you excitement in terms of treating patients/learning. What really interests you, beyond enjoying a chapter out of book. What is your passion?

 

[AlbinoHawk DO]

I'm biased, but i would say IM gives you enough general medicine training while leaving doors open for fellowship. Otherwise, I'd say neurology is the most interesting of the others. You won't go wrong picking any of the fields you suggested

 

[Redpancreas]

Okay I'm a third year D.O. Canadian (need visa) with level 1 score of 428 (just passed) and 50-75th percentile class ranking and no usmle.

Long story short I wanted to do psych and Neuro in undergrad and still am very interested in these subjects, coming into medical school I was aiming for psychiatry. It just so happens my psychiatry rotation elective is my last elective of the year so I have not actually gotten a feel for how the day flows, what the work flow feels like. But by May we will have already submitted VSLO applications for away rotations and pretty much decided on which specialty we want to do so I can't wait until then.

Then comes family medicine, I really liked my FM rotations and felt I actually got to navigate the patients lives and identify problems in their personal lives/work around their personality and provide counseling for patients, history taking etc which is what I liked a lot about psychology and psychiatry in undergrad, I realize I don't need the psychiatry medicine management as much in my life but feels the focused and in-depth interviewing and focused treatment navigation parts I really do like. I was pretty swayed into the field of family medicine but during the rotations I could see myself possibly burnt out from the task jumping and vast amount of paperwork in family medicine, and perhaps the long hours of patient time (as an introvert I find tiring to be 'on' all the time). I'm saying that because I do value being in a focused "flow state" at least some of the time in my future career, does anyone have any input as to my observation that family med may not be very "flow" friendly or introvert burn out?

I have a background in neuroscience and find the subject very interesting, although it is tougher for me to work with the patients who are very disabled and very sick, however for outpatient clinic I really enjoy the flow of things and being able to do a neurology physical exam. I find myself in the flow state often and I tend to like how neurology thinks about problems, but I wonder if its because I'm more comfortable with the diseases and have better grasp of it than some other medical areas.

I'm now in IM and liked inpatient environment more than I thought I would, I really enjoy being in the internal medicine team and thinking and discussing about challenging medical problems with other physicians, the focused patient encounters are also nice (I would say I enjoy outpatient encounters more but also get worn out faster from the social interaction). I also really enjoyed gynecology in my OBGYN and could imagine doing something with gynecological procedures and counseling in the future.

I'm trying to decide on which field I should go into based on my interests and suitability but I'm very stuck and need some advice. I realize my scores are limiting but I would rather try for a reach field and apply to some backup places than not try at all, or right now, not being able to decide at all 🙁

Take USMLE Step 2 CK and try to do at least average. You'll need that to boost your application, especially if your COMLEX scaled score shows up. Psychiatry is more competitive these days and as a DO/Canadian you're at a disadvantage (I'm sure this is your first time hearing that). One could make the argument that if you do poorly, you hurt your chances. To that, I'd say you're hurting them already with your current profile and a below average USMLE Step 2 CK is consistent with your current profile.

Apply to Psychiatry regardless and pick another field (IM/FM or OB/GYN). I'd drop OB/GYN unless you like that better than IM/FM because it'd be hard to have an application juggling Psychiatry, IM/FM, and OB/GYN and any programs that like you based on your story/personality may be left wondering what you actually want to do. OB/GYN is also slightly more competitive than FM/IM mainly due to lesser spots.

Also, I wouldn't judge FM on the paperwork. When you've got your real gig, there will be a system to automate a lot of that. The field in many ways is the most rewarding given its breadth and if you dedicate yourself to your patients instead of seeing it as a just a job, you can make a tremendous difference in your patient's lives.

 

[summergirl]

Just to offer another perspective, I also needed a visa and matched psych last year. Just from a visa/citizenship standpoint, FM and IM are going to be the easiest to obtain a visa in, especially IM. Psych is a lot more difficult to get a visa in, especially H1B visa. Last year I called each one of the ~52 H1B psych programs and it turned out only about 35-ish actually offers the H1b visa to people they didn’t already know (i.e. someone who didn’t go to Med school there). I didn’t research Obgyn but i believe it’s generally a bit harder to match in then psych, so I don’t think the visa situation will be any better.

The other thing is, do you want to stay in the USA after residency or go back to Canada? Check to see which US-trained specialty you can directly go back to Canada with. I know FM definitely can. Psych you’d need a fellowship. IM I think also needs a fellowship. Don’t know about on/gyn. The number of residency years has to match. This is important because many people would rather live in Toronto for 2 years to wait out the 2 years home country requirement rather then work in the middle of nowhere in the US for 3 years.

FYI, my personal recommendations given visa considerations: FM > IM > psych >>> Ob/Gyn. I chose psych because I loved it too much, but I recognize that my visa situation was significantly impairing.

 

[SereneApple]

I'm biased, but i would say IM gives you enough general medicine training while leaving doors open for fellowship. Otherwise, I'd say neurology is the most interesting of the others. You won't go wrong picking any of the fields you suggested

is a sub 450 score okay to apply for neurology?

 

[chillingpanda]

You can probably only match FM with that score

 

[DO2015CA]

is a sub 450 score okay to apply for neurology?

Depends on how your level 2 does. Neurology as a field also tends to like usmle even if it’s a low score. I wouldn’t recommend taking it unless you sure you your knowledge gaps first

 

[DO2015CA]

You can probably only match FM with that score

Nah but it’s not a good look. There are community IM possibility, peds, PMR tends to not care as much about scores. There will have to be serious improvement for level 2 to expand the selection though

 

[AlbinoHawk DO]

is a sub 450 score okay to apply for neurology?

In my opinion, no. You should focus on attainable specialties: IM (community), FM, Pediatrics, and Pathology

 

[SereneApple]

Nah but it’s not a good look. There are community IM possibility, peds, PMR tends to not care as much about scores. There will have to be serious improvement for level 2 to expand the selection though

yeah I could have done better but I ended up leaving almost 60 questions blank so I will work on the time for my level 2

 

[DameJulie]

In my opinion, no. You should focus on attainable specialties: IM (community), FM, Pediatrics, and Pathology

What about psych?

 

[DO2015CA]

What about psych?

Not with recent years competitiveness. It used to be a pulse to match but not anymore. It’s mid-competitive now

 

[AlbinoHawk DO]

What about psych?

Probably out of reach with those scores unless this person has a long track record of showing psych interest including sub-i

 

[BuildingMyOwnLuck]

Not with recent years competitiveness. It used to be a pulse to match but not anymore. It’s mid-competitive now

Is it really that bad though? On the interactive charting whilst a low comlex is not the best, it doesn't look like the end of the world. Maybe I'm missing something.

 

[Neopolymath]

Is it really that bad though? On the interactive charting whilst a low comlex is not the best, it doesn't look like the end of the world. Maybe I'm missing something.
View attachment 352076

New charting outcomes will be published this summer so I wouldn't even worry about this conversation, honestly. It's analysis of old info in a rapidly changing environment if nothing else but based on far more students and focus on lifestyle coinciding with people knowing psych makes plenty of money. Previously people commonly didn't know that for some reason.

 

[AlbinoHawk DO]

Is it really that bad though? On the interactive charting whilst a low comlex is not the best, it doesn't look like the end of the world. Maybe I'm missing something.
View attachment 352076

I met two people that match with <500 and both people had bachelors in psych and a ton of other psych projects before and during medical school