general guidance with specialties

[sav_b1]

Hi everyone!

First time posting in the medical student forum, so I apologize if I have posted this thread in the wrong area. I just wanted to reach out for some general guidance with respect to this issue (I will also have to put in a lot more research, this thread would just be to point me in the right direction).

I'll be starting med school this year, and due to the specific degree program I'm in, I will most likely have to begin planning/ logistics/ work that relates to my future specialty very quickly after beginning, and definitely before I begin my clinical years. However, at this point in my life I have VERY limited experience. I'm trying to get at least an idea of what specialties would interest me in the future.

My highest priority is being able to pursue research, and I'm looking for an area that is really intellectually (/diagnostically?) challenging. I do enjoy the more procedural side of things as well, though. Some of the docs I work with have noted that they see me in a field like ID or heme/ onc.

ALL of my experience so far has been in a neuro setting. I love the research side of this work so much. However, I've been told that neurosurg would not be as cognitively stimulating as I'd be looking for, and I have no background on what neurology is like.

I'm also passionate about women's health and love working with pediatric patients. However, my primary interest is going into a field that presents really cognitively challenging cases.

Thanks so much for your help!!

---

Members don't see this ad.

 

[themoonman2]

I'm just about to finish my third year and feel like I can say that all specialties have their own interesting areas of research that you can join depending on the institution you end up at and career goals you have. The actual day to day of practicing the medicine varies quite a bit with surgical specialties and neurology/medicine. Surgical diagnosis often are less complicated to reach with less tests that need to be ordered. That being said, surgical specialties can be very interesting (at least to me) in terms of the procedures offered and how they achieve their goal.

ID and heme/onc are definitely intellectual fields where you need to have a broad differential and really know what tests to order to get to the bottom of things, plus they also have lots of research potential.

A thing to keep in mind is how much basic lab research you would like to have in your career. It's much harder for a surgeon to run a basic science lab than certain medical specialties or neurology.

Once you start school, go shadow various specialties you're interested in ASAP- faculty are often very open to it- and ask them the questions that are important to you.

 

[nimbus]

Electrophysiology is a good combination of diagnosis and procedures.

 

[sav_b1]

I'm just about to finish my third year and feel like I can say that all specialties have their own interesting areas of research that you can join depending on the institution you end up at and career goals you have. The actual day to day of practicing the medicine varies quite a bit with surgical specialties and neurology/medicine. Surgical diagnosis often are less complicated to reach with less tests that need to be ordered. That being said, surgical specialties can be very interesting (at least to me) in terms of the procedures offered and how they achieve their goal.

ID and heme/onc are definitely intellectual fields where you need to have a broad differential and really know what tests to order to get to the bottom of things, plus they also have lots of research potential.

A thing to keep in mind is how much basic lab research you would like to have in your career. It's much harder for a surgeon to run a basic science lab than certain medical specialties or neurology.

Once you start school, go shadow various specialties you're interested in ASAP- faculty are often very open to it- and ask them the questions that are important to you.

Thank you so much! This gives me a lot to consider. Hopefully I can start talking to faculty soon and narrow down the possibilities. Thanks for the guidance!

 

[sav_b1]

Electrophysiology is a good combination of diagnosis and procedures.

Had not considered this! Thank you so much!

 

[700825]

Just a side thought, but you mention being interested in peds/women's health...have you considered medical genetics and/or maternal fetal medicine? To my understanding both are very conducive to research and would allow you to work with your desired patient population. I'd also imagine heme/onc, ID, or Neuro would be conducive to research, but I'll leave that to someone better versed in those fields.

 

[jdh71]

Hi everyone!

First time posting in the medical student forum, so I apologize if I have posted this thread in the wrong area. I just wanted to reach out for some general guidance with respect to this issue (I will also have to put in a lot more research, this thread would just be to point me in the right direction).

I'll be starting med school this year, and due to the specific degree program I'm in, I will most likely have to begin planning/ logistics/ work that relates to my future specialty very quickly after beginning, and definitely before I begin my clinical years. However, at this point in my life I have VERY limited experience. I'm trying to get at least an idea of what specialties would interest me in the future.

My highest priority is being able to pursue research, and I'm looking for an area that is really intellectually (/diagnostically?) challenging. I do enjoy the more procedural side of things as well, though. Some of the docs I work with have noted that they see me in a field like ID or heme/ onc.

ALL of my experience so far has been in a neuro setting. I love the research side of this work so much. However, I've been told that neurosurg would not be as cognitively stimulating as I'd be looking for, and I have no background on what neurology is like.

I'm also passionate about women's health and love working with pediatric patients. However, my primary interest is going into a field that presents really cognitively challenging cases.

Thanks so much for your help!!

These days generally speaking the more procedural your specialty the less “intellectual” from a big diagnostic perspective. The heavy lifting on work ups is predominantly carried by the generalists. At least in the adult side. With the kiddos because what they have when they have it tends to be less common the specialists do a lot of work up. The world needs more pediatricians. Hope you end up liking peds of some variety and find a specialty there. Pediatric neurology might be a good fit intellectually for you. It is lacking a lot of procedures - LP for sure and if you can do pediatric EMG you will worth your weight in gold for what you can do.

I’ll plug adult pulmonary and critical care. A lot of diagnostic work ups both in the ICU and pulmonary clinic. Bronchoscopy is a straightforward procedural modality but it’s not flashy or terribly exciting (unless you do biopsy and someone starts bleeding a lot!). The ICU will give you the chance to do intubation, central lines, dialysis catheters, swam-ganz catheters, arterial lines, and thora/paracentesis +/- LP. The hours can be long and it’s a nights weekends holidays anniversaries kids soccer games kind of specialty.

You really need to sort out first how much and how extensive of a proceduralist you want to be. Which I think means decide OR or no OR.

 

[Baller2016]

Ophthalmology is an excellent combination of amazing short surgeries (to fit your procedural desire) while also being diagnostically/clinically challenging, which is hard to know as a medical student (but trust me as a resident physician, it is incredibly stimulating). You are ordering all sorts of tests to pinpoint the correct diagnosis. You are also curing/preventing blindness, which is an incredibly noble endeavor and makes you feel rewarded at the end of the day. Patients are VERY grateful for your work.

Lastly, ophthalmology is a very research-intense specialty. There is still so much to discover and because it is very technology driven, there is always room for new devices/innovations/developments.

You also make great money as an attending/partner ($350-450k+ with retinal surgeons making ~$550/600k+; high-end cataract/refractive surgeons can make millions) with a very controllable lifestyle (8-4,9-5 with no weekends).

I'd recommend shadowing an ophthalmologist but heme/onc, ID, neuro are also all great specialties. Keep an open mind as an MS1/MS2/MS3!!

 

[MEN2C]

I’ll plug in Pedi specialties. The specialties have built in two years of research during fellowship too. You won’t make as much money as your adult counterparts though.

 

[Angus Avagadro]

Neurology has probably the best diagnosticians. If you stump a neurologist, you have done something. Lots of very stimulating research on Multiple Sclerosis, ALS, and Stroke. Not here procedure heavy though. Lots of imaging. Good luck and best wishes.

 

[babybrains]

These days generally speaking the more procedural your specialty the less “intellectual” from a big diagnostic perspective. The heavy lifting on work ups is predominantly carried by the generalists. At least in the adult side. With the kiddos because what they have when they have it tends to be less common the specialists do a lot of work up. The world needs more pediatricians. Hope you end up liking peds of some variety and find a specialty there. Pediatric neurology might be a good fit intellectually for you. It is lacking a lot of procedures - LP for sure and if you can do pediatric EMG you will worth your weight in gold for what you can do.

I'd agree with this, though I'm obviously biased. Neurology is arguably the most intellectually stimulating field, with a heavy emphasis on research, but not particularly heavy on procedures. If you're interested in working with kids, child neuro is a great specialty to consider - you get to see a lot of diagnostic challenges that often require digging into case reports to fully understand, but you also get to see healthy kids and provide reassurance at times. Fellowship may help a little with procedures - neuromuscular would definitely provide opportunities to do EMG, movement disorders can do botox, etc.

tl;dr: Child neuro is a great fit for your interests in cognitively challenging cases, research, and pediatrics, though generally doesn't provide much in the way of procedures.

Someone also mentioned medical genetics - that's also a great field for unusual, challenging cases and pediatrics/women's health, though from what I've seen there are even fewer procedures. Not super familiar with the research side of things there.

 

[Deecee2DO]

Electrophysiology is a good combination of diagnosis and procedures.

EP is post-cards fellowship correct?

 

[Deecee2DO]

Allergy is honestly very cool as well. Shadowed an Allergist the other day and there is a lot of puzzle solving-people come in with a history of weird allergic reactions not knowing where they came from and skin rashes that you have to find out the source/what is causing the allergy. Allergy medicine you also have some great research opportunities like primary immunodeficiencies and novel methods on treatments for certain allergies

 

[HelpPleaseMD]

EP is post-cards fellowship correct?

yep

 

[Deecee2DO]

yep

lol holy smokes thats as long as NS

 

[Raryn]

lol holy smokes thats as long as NS

Longer.

3 years of IM, 3 years of cards, 2 years of EP (used to be 1, they increased it).

 

[nimbus]

Longer.

3 years of IM, 3 years of cards, 2 years of EP (used to be 1, they increased it).

Definitely not a specialty for those in a hurry. I work with an EP who graduated med school in 1998. Did IM Chief year and a couple of research fellowships. He completed his EP fellowship in 2013. Excellent doctor. (A DO for those who care.)

 

[longhaul3]

Longer.

3 years of IM, 3 years of cards, 2 years of EP (used to be 1, they increased it).

Since you're comparing total training including fellowship, most neurosurgeons will train through at least PGY-8. Some will complete a fellowship within 7 years ("enfolded") and some will go through PGY-9.

I once had a preceptor who was a newly minted attending in TAVR/structural heart who had gone through PGY-10. Total badass.

 

[Deecee2DO]

Longer.

3 years of IM, 3 years of cards, 2 years of EP (used to be 1, they increased it).

haha incredible

 

[nlax30]

EP is a great field. Don't remind me about the length though..... done with PGY-8 year in a few months.

 

[Little Green Mensch]

The best thing to do is pick out the fields that sound appealing to you now, and do as much shadowing as possible before your schedule gets busy. For us, M1 was much more sedate than M2, and it would have been difficult to shadow during almost all of M3. Figure out when would be the best times (and ask your school for advice if you're not sure).

I wouldn't rule out procedural fields, either. Thinking over complex differentials can be fun, but it can also be really frustrating to watch a patient deteriorate and not know why. There's also a decent amount of clinical judgement involved in whether or not to recommend (or even offer) an operation - surgical decision-making is not, and should not be, entirely algorithmic (excepting trauma, although those guys also do critical care).

 

[enalli]

I'll be starting med school this year, and due to the specific degree program I'm in, I will most likely have to begin planning/ logistics/ work that relates to my future specialty very quickly after beginning, and definitely before I begin my clinical years.

This doesn't make sense. Are you starting an accelerated 3-year curriculum? Even in those, you should have time to decide on your specialty after clerkships.

As others have alluded to, any field can be as cognitively demanding and research-intensive as you wish. After appropriate training in any sub-specialty, most of your work will still be pattern-recognition. You're not going to be out there re-inventing the wheel every single day--real medicine isn't like the show House.

 

[Detailfanatic]

Interventional radiology!

 

[SurfingDoctor]

If research is your passion, you probably should pick a specialty which most aligns with your research interests.

Generally speaking, being a proceduralist and research don’t go hand in hand. I’m not saying they can’t be, but you aren’t going to be spending scheduled time in the procedure suite when you are having to write grants and papers.

Thus, it depends on your priorities. If research is your priority, you gear your career choices toward that, if your prior is procedures, you hear your career choices to that. As an aside, most subspecialites that are “intellectual” have people who are heavily research dependent to support salary, mostly because pontification has poor reimbursement.

 

[irwarrior]

The 6 year interventional radiology residency is an interesting field that students can now apply directly from medical school. It is an intriguing specialty in great transition as it starts to move away from its roots of diagnostic imaging and pure procedural component to incorporating more and more direct patient care as well as longitudinal and comprehensive care components.

The IR practice can be quite diverse. IR physicians treat patients from head to toe and various age populations from pediatrics to the elderly. IR has grown in the scope and breadth of who they treat.

They treat a lot of oncologic conditions including hepatocellular cancer with (TACE or Y90 (direct arterial injection of chemo or radiation into tumor), RF and microwave ablation, portal vein embolization). They burn or freeze lung cancers or lung cancer metastases. We freeze kidney cancers (T1a /small renal masses) and palliate metastatic bone tumors with cryoablation or ablation and do cementoplasty for these lesions.

We treat women with excessive bleeding from fibroids with uterine artery embolization and reopen Fallopian tubes in women with infertility, we also help patients with pelvic congestion syndrome with pelvic pain without other definable cause, we treat postpartum hemorrhage with embolotherapy in the emergency situation as well as the occasional placenta acreta /percreta etc.

Some IR treat patients with vascular conditions including lymphatic /venous malformations and peripheral AVMs. Patients with peripheral arterial disease and critical limb ischemia as well as some patients with visceral and aortic aneurysms. We also treat patients with DVT/PE with thrombectomy (angiovac/penumbra/ekos/flowtriever/clottriever/jeti) and place and remove IVC filters. We also treat varicose veins with sclerotherapy , endovenous ablations and ambulatory phlebotomy. We also deal with the ESRD patient population placing peritoneal dialysis catheters, placing AVF and maintaining av grafts and fistulas and placing dialysis catheters.

We also do some pain interventions including management of compression fractures with kyphoplasty, vertebroplasty, coblation, and spinejacks. We also do epidural injections and rhizotomy.

We also do nephrostomy tubes for urinary obstruction and prostate artery embolotherapy for BPH with urinary outflow obstructive symptoms.

Also we biopsy lesions throughout the human body and drain abscesses.

A relatively new field that became its own specialty in 2012 and a relatively new residency training program (last 3 years). You can learn more about it at rfs.sirweb.org.

Depending on what you make of it, I believe all fields of medicine have a cognitive component . Good luck though medicine can be a demanding field, taking care of patient's and their families can be highly rewarding.

 

[ricksimmonsrafowens]

I've been told that neurosurg would not be as cognitively stimulating as I'd be looking for

What kind of a person said that? That's a very dubious claim lol

There's a lot of responsibility to patients in managing their neurologic disease... Neurosurgeons make difficult and life altering decisions frequently and there is a lot of critical thinking that goes into various surgical approaches etc. I have great respect for neurologists but it's one thing to diagnose and another to treat surgically... The level of responsibility to the patient for any bad outcome is extremely different.