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BlondeDocteur

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I'm an MS3 who has to plan out 4th year next week. I'm caught between two very different specialties: neurology and surgery.

The reason I'm posting this private decision on a public board is because, in my experience, surgery is a very polarizing field. Most students love it or hate it. And many (most? all?) people in surgery say they would never have been happy doing anything else in medicine.

I feel like these two fields appeal to two sides of my personality. I love the thinking, the analysis, the intellectualism of neurology... I feel like neurologists really and truly try to figure out what's going on with their patients, unlike say internal medicine where things seem to be done quickly according to algorithm. But at times I find it slow, frustrating and too much of a spectator sport.

I loved every minute of my surgery clerkship... though I did think the floorwork was sloppy (30 second physical exams and 1 minute interviews?). I loved the acuity, interventionalism and the wide range of pathology.

I was lucky in both clerkships to get rave evals-- "best student I've ever seen" sort of stuff-- and both noted that I was "perfect for this field". I don't have the world's highest board scores but I do have a nifty CV and it was strongly intimated by the PDs in both fields that I could stay at my home school for residency if I so choose-- and I feel that both neurology and surgery are awesome programs here.

So my question is-- did most of you know you would go into surgery? Did you consider anything else? Do you think that someone who is seriously considering two specialties, one with considerably better hours than the other, should just take the easy lifestyle way out? And lastly, if I arrange the first few months of 4th year exploring both-- surgery, neurology, surgery, neurology-- how do you think that would look on a residency app?

Incidentally, I have no interest in neurosurgery. Idiosyncratic I know, but I actually find their bread and butter a little boring, and think they work way too hard for such poor outcomes.
 

purplefish

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I'm an MS3 who has to plan out 4th year next week. I'm caught between two very different specialties: neurology and surgery.

The reason I'm posting this private decision on a public board is because, in my experience, surgery is a very polarizing field. Most students love it or hate it. And many (most? all?) people in surgery say they would never have been happy doing anything else in medicine.

I feel like these two fields appeal to two sides of my personality. I love the thinking, the analysis, the intellectualism of neurology... I feel like neurologists really and truly try to figure out what's going on with their patients, unlike say internal medicine where things seem to be done quickly according to algorithm. But at times I find it slow, frustrating and too much of a spectator sport.

I loved every minute of my surgery clerkship... though I did think the floorwork was sloppy (30 second physical exams and 1 minute interviews?). I loved the acuity, interventionalism and the wide range of pathology.

I was lucky in both clerkships to get rave evals-- "best student I've ever seen" sort of stuff-- and both noted that I was "perfect for this field". I don't have the world's highest board scores but I do have a nifty CV and it was strongly intimated by the PDs in both fields that I could stay at my home school for residency if I so choose-- and I feel that both neurology and surgery are awesome programs here.

So my question is-- did most of you know you would go into surgery? Did you consider anything else? Do you think that someone who is seriously considering two specialties, one with considerably better hours than the other, should just take the easy lifestyle way out? And lastly, if I arrange the first few months of 4th year exploring both-- surgery, neurology, surgery, neurology-- how do you think that would look on a residency app?

Incidentally, I have no interest in neurosurgery. Idiosyncratic I know, but I actually find their bread and butter a little boring, and think they work way too hard for such poor outcomes.

I would never consider another field of medicine beside surgery. The only valuable thing that I can say to help you decide between surgery and neurology is to work until you are extremely tired (do many call nights q2s)- then think about what would make you happiest. Good luck
 

Leforte

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Consider becoming a neurointensivist. Take care of extremely sick patients, do a variety of ICU procedures, and can ponder to your hearts content on rounds, etc. And you won't have to worry about short H&Ps/physicals.

You'll get the "acuity, interventionalism and the wide range of pathology" that you love.

I think the pathway is neuro (4 years) + 1-2 years Neurointensivist fellowship. Works out to about the same length as surgery.
 
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TXSurgResident

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Start with sub I's in both and go with your gut from there. Even if you go as far as to match in one or the other and decide you chose poorly, switching after intern year is not the end of the world.

Or neurosurgery...

(I also loved Neurology in med school, took lots of electives in it. I think I still do, but as you said- just a little too much of a spectator sport for me)
 

balaguru

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I went into med school thinking surgery cause "I liked to work with my hands" but kept an open mind throughout. By the time I started 3rd year I was leaning towards IM and neurology. I really enjoyed IM and FM and ruled neurology out 1 week into my rotation for reasons that probably had more to do with my program. Then I took surgery late during 3rd year and it just clicked. I could probably have been happy doing primary care just not as much as I think I'll be doing surgery. If I were younger and single I might even have double boarded. Not sure how that would work in practice, though.

With respect to planning 4th year and how this might look to programs, I don't think it matters at all. Those first few months are there for your benefit to figure stuff out and get recommendation letters. Perhaps someone who has sat at the other end of the desk during residency interviews can comment on this.
 

bott1637

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I think you are doing exactly the right thing with your fourth year. You are doing you best to make an inteligent decision. As long as you can explain that and why you make the choice you do to a PD then you are golden. If I were a PD I would want the person who thought long and hard as you seem to be doing before picking.

I also enjoy the "cognitive" specialties very much, and like neurology. I just liked the instant gratification too much. Diagnosing a fifty something year old lady with parkinson's and knowing there is nothing I am ever going to be able to do stop her decline was the final straw for me.
 

jubb

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I totally wavered. I told the story of wavering in my interviews all the time. I was totally in love and getting married and I didn't want to have crappy life. Our med school had just had a lecture about how everybody sweeps Doctors problems under the rug and how doctors have the highest suicide rates, accidental deaths alone, drug problems, alcohol problems, and divorce rates and affair rates. That pushed me into a lifestyle and lots of money focus cuz I didn't want all those horrible things. Lifestyle big buck career dreams are hard to let go of but I just realized I couldn't sell out like that and If I'm staying late at the hospital it's going to be cuz I'm saving someone's life and not cuz it's how you milk the system, and I usually feel good staying late on a big case that is saving someone's life. I love being scrubbed in a big surgery. Time goes by quickly and enjoy it. As I got further and further into 4th year I realized there is no way I could have done any of my second and third choices for specialty.
 

BlondeDocteur

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Honestly, thanks much for the advice everyone. I actually took it-- doesn't that make you feel good!

Registration just ended so here's what I'm doing:

July: Neurology Consults
August: Pediatric Surgery sub-internship
September: Preceptorship in Vascular Surgery

If I find I love neurology I can switch the September month and still get my application together in time for the Match. If surgery is where I'm headed then I'll keep the current schedule and be set for the surgery match. (Honestly, neurology is on trial here. I feel I'll love surgery regardless, but the question is would I be happy as a neurologist.)

Thoughts?
 

Pir8DeacDoc

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I'm not sure pedi surgery is your best option for a sub-I but I imagine that could be variable by hospital. As a student you'll probably never lay suture to skin during that month. I would have gone for something like plastics where you can suture like mad for a month. But either way, good look with the decision making process.
 

BlondeDocteur

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It's a fair point. It's an especial interest of mine (love those congenital malform cases) and I thought I'd like to rotate through, even if I opt against surgery.

It's a popular sub-i here as we have a high operative case load due to the children's hospital and a peds surg fellowship program in-house. And after all, not every patient is a 2 day old micropreemie with 8 congenital cardiac anomalies... sometimes they're 15 year olds with appys. So students do get a chance to put down the yankauer every now and again.

Thanks for your advice!
 

mules05

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I'm wavering, too, but between fields that are somewhat more related. I did my OB/gyn rotation first this year, and loved it, except for the one week in clinic. I'm now on surgery, and loving it. I also liked some aspects of medicine, and realized that I'd be unhappy managing primarily healthy patients. Don't get me wrong, I have no interest in managing someone's hypertension or diabetes, but the aggressive management of critically ill patients appeals to me. I know I'd be unhappy if I was in a non-surgical field, but now I can't figure out which one to choose. Since it's been so long since my ob/gyn rotation I can't remember if I liked it for the surgeries or the actual gyn, although I do remember liking laparoscopic cases and open abdominal cases more than the vaginal cases. Did anyone else go through a decision like this? How did you make your final decision?

I have to figure out my 4th year schedule in the next week or so, so it seems like I need to make a decision quickly. As of right now my schedule is set up for an away in ob/gyn, followed by an open slot, which could be filled with another away or a surgery rotation at my institution (I know transplant, vascular, and ct are all available). 3rd I have a SICU month. If I decide on general surgery, is it poor form to cancel my away rotation? I also have a couple away applications pending at other schools, and would consider doing a gen surg elective at these places, but don't know how bad it would look to call them up and ask to change my course preferences to another specialty. Thoughts?
 
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galacticzoot

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I'm a third year medical student that is waivering between GS and OB/Gyn. SMQ123...you sent a PM to mules05 about this...can you offer me any advice?!?! I am deeply concerned about lifestyle issues associated with both of these specialties. I feel like I can easily get into a big group private practice in OB/GYN and have a decent life (in a big practice, the call schedule can be pretty tolerable). Is it possible to have a decent life in surgery without having to go into a specialty like Breast surgery or Hand surgery? Can you have a life in Trauma surgery? I'd appreciate any in put about the pro's/cons of both of these fields! Thanks!
 

SocialistMD

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...realized that I'd be unhappy managing primarily healthy patients. Don't get me wrong, I have no interest in managing someone's hypertension or diabetes, but the aggressive management of critically ill patients appeals to me.

If you go the OB-Gyn route, you will see more "primarily healthy patients" than critically ill patients, unless you do Gyn-Onc, in which case the intensivist will be taking care of your critically ill patients. The OB-Gyn training doesn't cover much critical care outside of managing obstetric emergencies.

galacticzoot said:
Is it possible to have a decent life in surgery without having to go into a specialty like Breast surgery or Hand surgery? Can you have a life in Trauma surgery? I'd appreciate any in put about the pro's/cons of both of these fields! Thanks!

At many academic institutions, trauma surgery has become shift work for the attendings as well as the residents. You would be looking at a week on days (6a-6p), a week on nights (6p-6a) and a week off (a fourth week of ICU could be thrown into the mix if you wanted to do critical care also). So, in answer to your question, trauma can be very lifestyle friendly if you don't mind working a week of nights every month (it does afford you the true "academic week" where you are completely removed from clinical duty; something not seen in the other surgical specialties).
 

smq123

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I'm a third year medical student that is waivering between GS and OB/Gyn. SMQ123...you sent a PM to mules05 about this...can you offer me any advice?!?! I am deeply concerned about lifestyle issues associated with both of these specialties.

Honestly, for me, lifestyle considerations were somewhat secondary in the "OB/gyn vs. surgery" debate. I had pretty much accepted that, no matter which field I chose, there was a high likelihood that my lifestyle was going to suck. After I accepted that (somewhat depressing) fact, it really boiled down to which field I could see myself in.

I'll send a copy of that PM to you as well. Hopefully it will help. :luck:
 

mules05

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Honestly, for me, lifestyle considerations were somewhat secondary in the "OB/gyn vs. surgery" debate. I had pretty much accepted that, no matter which field I chose, there was a high likelihood that my lifestyle was going to suck. After I accepted that (somewhat depressing) fact, it really boiled down to which field I could see myself in.

I had brief thoughts about the lifestyle issues while debating fields, and I've definitely thought to myself that life would be so much easier if I liked outpatient peds or family practice. I'm sure if I did one of those (or really, lots of other fields with fewer hours) my life outside of work would be better- I'd have more time to spend with my family, more time to make dinner and get pedicures or whatever. But I'd dread going to work each day. I used to wake up on my psych rotation (at 8am) and not want to get out of bed. On my surgical rotations, I wake up and instead of thinking "holy crap, it's 4am" I'm wide awake and excited to go to the OR that day. My difficulty is just in figuring out which surgical specialty, despite the lifestyle, is right for me.
 

smq123

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I'm sure if I did one of those (or really, lots of other fields with fewer hours) my life outside of work would be better- I'd have more time to spend with my family, more time to make dinner and get pedicures or whatever. But I'd dread going to work each day. I used to wake up on my psych rotation (at 8am) and not want to get out of bed. On my surgical rotations, I wake up and instead of thinking "holy crap, it's 4am" I'm wide awake and excited to go to the OR that day. My difficulty is just in figuring out which surgical specialty, despite the lifestyle, is right for me.

:) I DO know exactly what you mean! I don't know if you've done your IDEPTs yet, but I did ophtho for one of mine. The lifestyle was fantastic...you'll never meet nicer, happier residents....but I just could NOT force myself to like it. I didn't dread it when I woke up in the morning, but I couldn't get fired up about it.

On the other hand, I didn't want to leave the hospital each day on OB. During surgery, the intern had to push me out of the SICU. I really just had a great time and didn't want to leave.

Dr. K.C. (current residency director at the home institution) gave a talk on women in surgery a year ago - and that's what she said really motivated her to pick surgery as well. She said that she was always a little sad to leave at the end of the day on her surgery rotation - and that this was a good clue as to what really excited her.
 
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Blade28

She said that she was always a little sad to leave at the end of the day on her surgery rotation - and that this was a good clue as to what really excited her.

Ah...reminds me of:

"The only bad thing about being on Q2 call is that you miss 50% of the good cases."
 

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I started my third year rotations thinking, "I'll do anything BUT surgery - I don't want to work with those jerks." I started in general surgery at a community hospital with just enough trauma to keep it interesting and had a complete identity crisis. I loved it!

As a fourth year student, a radiologist trying to dissuade me made the following arguement... "Wouldn't you rather hate your job for 8 hours a day rather than love it for 14?" I think the answer to that - at the end of three years of general surgery residency is a resounding no.

Do what makes you excited. If you don't have enough of those home run moments during your work, you won't survive.
 

Winged Scapula

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I started my third year rotations thinking, "I'll do anything BUT surgery - I don't want to work with those jerks." .

That was my stance too...never mind that I had never met a surgeon and certainly didn't know any. I KNEW they were jerks and I would't like it.

Dial up 10 years later....:D
 
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Blade28

As a fourth year student, a radiologist trying to dissuade me made the following arguement... "Wouldn't you rather hate your job for 8 hours a day rather than love it for 14?" I think the answer to that - at the end of three years of general surgery residency is a resounding no.

IMHO, that sort of reasoning makes no sense to me.
 

smq123

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IMHO, that sort of reasoning makes no sense to me.

I know - it's kind of a dumb idea if you think about it. "Sure...8 hours of sheer misery is TOTALLY worth the guaranteed weekends!" But I've had that argument pushed towards me a lot of times, surprisingly.

And I don't understand why people think that that argument holds water. Don't they think that I've already experienced "lifestyle" rotations as a third year? Don't they think that I can accurately identify boredom when I feel it?

The ER intern on L&D told me that "You should really think about EM, because the hours are good, and that's what really matters." Hmmm...that's not what matters to everyone...
 
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jubb

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The ER intern on L&D told me that "You should really think about EM, because the hours are good, and that's what really matters." Hmmm...that's not what matters to everyone...

I think ER is going to get creamed on reimbursements soon and their hours won't be so good if they want to make any money. They always quoted me these numbers like 12 10 hour shifts a month and you make 250k. I was at a lecture recently that said if the planned cuts go through ER docs will get a 12% cut in reimbursements. Then they'll have to up there 36 hour weeks to 40 hour weeks to make up for it. No big deal, but I think that trend will continue. No offense to other specialties, but if we are going to cut reimbursements lets cut them from the lifestyle specialties who are hardly working and not from those putting in 70-80hr weeks. I don't think the "work less make more" option should be out there.
 

kate0834tkjn

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I know - it's kind of a dumb idea if you think about it. "Sure...8 hours of sheer misery is TOTALLY worth the guaranteed weekends!" But I've had that argument pushed towards me a lot of times, surprisingly.

And I don't understand why people think that that argument holds water. Don't they think that I've already experienced "lifestyle" rotations as a third year? Don't they think that I can accurately identify boredom when I feel it?

The ER intern on L&D told me that "You should really think about EM, because the hours are good, and that's what really matters." Hmmm...that's not what matters to everyone...

But don't most of the people who play the "you will wish you'd chosen a lifestyle or better paying specialty" card say that they didn't think this would matter to them third/fourth year, too? That seems to be the pattern where I'm at school.....

For me, it's kind of scary as a third year to hear this because I really don't feel my 10-ish months of clinical experience really qualify me to make a career decision. I mean, 2-3 month surgery/IM/peds rotation as a third year medical student is quite different than a 20-30 year career (or even 2-3 years as a resident), and for me, it's quite frightening that I'm making such a big decision based on just a few months experience and extensive soul searching. When you add to that that I might just "think" I want to go into a certain specialty and will regret it in 10 years, I become downright terrified..... :)

Anyway, that was a little rambling, and I'm sure it's different for everyone, so I don't mean to sound like a know it all! Best of luck in making a tough choice!
 
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Blade28

For me, it's kind of scary as a third year to hear this because I really don't feel my 10-ish months of clinical experience really qualify me to make a career decision. I mean, 2-3 month surgery/IM/peds rotation as a third year medical student is quite different than a 20-30 year career (or even 2-3 years as a resident), and for me, it's quite frightening that I'm making such a big decision based on just a few months experience and extensive soul searching. When you add to that that I might just "think" I want to go into a certain specialty and will regret it in 10 years, I become downright terrified..... :)

No need to trivialize your fears - it IS a difficult decision!

In the same respect, though, didn't most of us decide to go into medicine (back in college) with relatively little true exposure to what the field was really like? None of us truly knew what it was like to be a doctor (no matter how much shadowing you did, or how many volunteering hours you accumulated, or how many weekends you spent with your uncle/dad/neighbor at their private practice).

It's scary because most other people change jobs many times over the course of their working career.
 

smq123

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But don't most of the people who play the "you will wish you'd chosen a lifestyle or better paying specialty" card say that they didn't think this would matter to them third/fourth year, too? That seems to be the pattern where I'm at school.....

No, you're definitely raising a good point.

But, for some people, it can be fairly clear cut. If I can't even tolerate a 3 week rotation in a lifestyle specialty, then how likely is it that I'm going to make it through a 3-4 year residency in that field? Not very.

If I have a huge feeling of euphoria after a 6 week easy rotation is over, should I really think about going into that field? Probably not.

And don't get me wrong - I am SURE that there will be lots of internal grumbling and complaining during residency. And I have briefly considered going into a field with a better lifestyle. But for me, it really has been a pretty clear decision between lifestyle vs. not-lifestyle. I know that not everyone has been that lucky, though.
 

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No, you're definitely raising a good point.

But, for some people, it can be fairly clear cut. If I can't even tolerate a 3 week rotation in a lifestyle specialty, then how likely is it that I'm going to make it through a 3-4 year residency in that field? Not very.

If I have a huge feeling of euphoria after a 6 week easy rotation is over, should I really think about going into that field? Probably not.

And don't get me wrong - I am SURE that there will be lots of internal grumbling and complaining during residency. And I have briefly considered going into a field with a better lifestyle. But for me, it really has been a pretty clear decision between lifestyle vs. not-lifestyle. I know that not everyone has been that lucky, though.

Yea, I guess you are kind of lucky in that you've narrowed it down, are convinced that lifestyle won't be a big enough issue to stop you from going into certain fields, etc. I guess I'm still trying to sort everything out, lifestyle factors included!

And Blade28, you're definitely right about going to medical school (somewhat) blindly and despite being discouraged by countless practicing physicians. Fortunately, it's worked out OK, at least so far.... :)
 

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No, you're definitely raising a good point.

And don't get me wrong - I am SURE that there will be lots of internal grumbling and complaining during residency. And I have briefly considered going into a field with a better lifestyle. But for me, it really has been a pretty clear decision between lifestyle vs. not-lifestyle. I know that not everyone has been that lucky, though.

When i think of 'lifestyle' I imagine things like weekends off and morning coffee and seeing daylight, etc. But in reality it's so much more enormous than that. I absolutely loved surgery and it was by far my favorite rotation, but decided to go into another specialty (not lifestyle, but easier). It was a difficult choice but I know I made a correct decision. If I did surgery I would enjoy every second of my job and would joyfully sacrifice everything to it, but I would miss out on many other aspects of the world that I am probably not even aware off right now. So for me it was a question of - do you want to do what you love 24/7 in a tiny closeted space or would you rather do what you love less, but have time to discover other unknown aspects of life. I can't sacrifice this much to do something I love, especially since I am not even sure at this stage of my life the extent of what I would be giving up.
 

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I think medical students' view of their careers are too romanticized. I doubt that there are so many people who "love" surgery and "hate" radiology. Surgery has its positives and negatives, as does radiology. Instead of 8 hours of misery, it's probably closer to 8 hours of comfortable boredom. And instead of 14 hours of bliss it's probably closer to 14 hours of painful but sometimes rewarding work. Now if you put it into those more realistic terms, the decision isn't as easy.

Anyone who thinks they will "love" surgery for all 14 hours a day, is rationalizing and in some serious denial. Many aspects of surgery are PAINFUL. Just read the threads on this topic posted previously. On the other hand, there are cool aspects of radiology and not all of it is pure misery. Stop rationalizing and base your decision on real introspection. If after some real thought, surgery is for you, then you should do surgery. But you shouldn't do surgery because you think it's always awesome, you will "love" it, or because you think you can't be happy doing anything else. Let's be honest, there are plenty of people miserable in surgery, who were once happy medical students just like you.
 
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Blade28

And Blade28, you're definitely right about going to medical school (somewhat) blindly and despite being discouraged by countless practicing physicians. Fortunately, it's worked out OK, at least so far.... :)

:thumbup: :thumbup:

When i think of 'lifestyle' I imagine things like weekends off and morning coffee and seeing daylight, etc. But in reality it's so much more enormous than that. I absolutely loved surgery and it was by far my favorite rotation, but decided to go into another specialty (not lifestyle, but easier). It was a difficult choice but I know I made a correct decision. If I did surgery I would enjoy every second of my job and would joyfully sacrifice everything to it, but I would miss out on many other aspects of the world that I am probably not even aware off right now. So for me it was a question of - do you want to do what you love 24/7 in a tiny closeted space or would you rather do what you love less, but have time to discover other unknown aspects of life. I can't sacrifice this much to do something I love, especially since I am not even sure at this stage of my life the extent of what I would be giving up.

Again, the thing with surgery is, many med students enjoy their MS-III rotation. Everyone likes "doing" things with their hands - especially if you had a great hands-on experience during your General Surgery rotation and your residents let you tie, cut, suture, etc. - and many like the fast pace.

But the thing is, you have to like it enough for the lifestyle and culture to not be a deterrent.
 

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I don't know... I think I would be pretty miserable in Radiology. I cannot imagine going through 8 years of training to sit in a dark room and look at pictures. I love working with patients and I can't imagine no longer doing that. If I just wanted a sort of fun job that made me a lot of money, I would have gone to business school. That is not why I went into this field. I cannot really think of any other pros for Radiology - unless maybe you go into IR...

Sure, there are some times in surgery where you feel like you got socked in the gut... there are a lot of things I don't enjoy in my job, but the essence of it is what makes me never complain about getting up at 4:30 in the morning for five years... romanticized or not - I've been doing this for a few years now, and my perspective has not changed.
 

BlondeDocteur

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A lot of people say that residents, for the first time in their lives often, have a domain of knowledge that's "theirs." It's a hard-earned body of knowledge to be sure, and just to have it makes them proud. It becomes part of their identity and they can scarcely imagine having done something else, and tell you such. When in reality, they might well have trained in another specialty, have acquired a different hard-earned body of knowledge, and feel the same way.

This isn't to say that some people genuinely make a poor choice, or that residents don't suffer from grass-is-greener syndrome (to which I think the neurotic obsessive-compulsive types in medicine are especially prone), but I do think that happiness in a specialty is overdetermined.

I also feel that for surgery in particular, Blade is right-- many med students love the rotation, since they do get to work with their hands. There are few med students who don't like procedures-- the question is, can they live without doing them. Surgery is fast-paced, it's sexy, it's appealing... and it's temporary for most of them.
 
B

Blade28

I also feel that for surgery in particular, Blade is right-- many med students love the rotation, since they do get to work with their hands. There are few med students who don't like procedures-- the question is, can they live without doing them. Surgery is fast-paced, it's sexy, it's appealing... and it's temporary for most of them.

I totally agree.
 

DrDre311

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I liked neurology as a med student...all the different pathways, localizing the lesion, puzzle solving, etc. Then, after a few weeks on the rotation, I realized we were rounding for 8 hours on 10 patients and no matter where the lesions were and how much fun it was to find them, we couldn't do a damn thing about the stupid lesions. Then, the 8-9 hours of rounds just made me want to shoot myself or jump out a window--whichever would make rounds end faster.
 
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