Help! 4th year student considering changing fields!

[La Fiera]

Crap!!
I thought I had everything figured out for what I was going to do in medicine but it just seems that I am either getting cold feet, or I really wasn't that happy to begin with my first choice anyway. If you have any advice please let me know especially since it is so late in 4th year and I have no other LOR to go into different fields, and haven't started on a new Personal statement.

I was convinced that I would go into Family Practice, so much that I accepted a full 2 year scholarship from the NHCS to do primary care. The catch is, if you should go back on your comittment to the NHCS, you have to repay them 3 times the amount that they loaned you- which would end up being $300,000 + in my case. This may seem like a lot, but in actuality, its not as bad as it sounds because I would have ended up paying this much interest had I taken out loans from the government and private companies.

I wanted to go into FP because of the continuity, the generality of the conditions and patients (young, old, sick, etc) seen, the fact that FP's affect more people than any other health care specialty (I'm talking numbers). Also, I really like working with my hands, and the procedures that FP's can do in the clinic (eg excision of moles etc.) or in the OR- eg. c-section really attracted me. Most of all, I like the fact that FP's can work in small rural ER's because there is no one else to do it! I love the ED! Furthermore, it seems as you can do so many different things with FP, that are not available in other fields.

Here's the problem that I started thinking about the last few weeks. I thought about whether or not I would be happy in FP and I couldn't say that I would with certainty- I imagined coming into the office and dreading seeing pts with Diabetes and HTN everyday where all I would be doing was adjusting meds. Or evaluating a pt's social situation and trying to see how I could work with it- (I want to be a doctor, not a social worker). And in a recent clerkship I did in FP all I seemed to see was chronic pain and just the things I am dreading. So my question to you is this- should I stick with FP in hopes of eventually find a job in a smaller ER, or maybe as a hospitalist because this is what I have already applied to and had a few inerviews in (not to mention that I have a scholarship in)?

The other options:
ER:
Something that I have always really enjoyed, but ruled out earlier b/c of 1. the lack of continuity, and not knowing if you really did the right thing with the patient (unless you follow them through the hospital course) 2. knowing the 1st few steps of how to take care of a med or surg pt but then not knowing how to continue care. 3. the scholarship I got to do primary care

Surgery:
I love working with my hands and I am good at it. But I do not want to be slave for the next 5+ years and then some. I like my life, I like going out and persuing other interests. Furthermore, I don't like laparascopic surgery- somehow the fun got lost in it. I really like Trauma surgery- but again thats a good 6 -7 year residency, which I might not even be guarenteed to get! Furthermore, 8 hrs in surgery would probably destroy my little ADHD mind.

Medicine:
Surprisingly, I really liked the ICU. Its general, and the physiology behind the diseases that you see in the ICU is absolutely fascinating to me. I know I couldn't specialize in one organ- I would get bored for sure. The problem with Hospitalists is that it seems as all they do all day is scutwork- call everyone else involved and get paged and then write ridiculously long notes.

OB/Gyne:
The problem with this is that you don't get to see any male patients, and not too many kids. Not too mention that you are a slave during residency just like the surgeons, and your malpractice is ridiculous.

So. There it is. I am also afraid that I left considering changing fields a little too long. I really screwed myself with ER and Surgery, as they are competetive and have sent out most of their invites to interview. I'd also have to get more letters from who knows? On top of that My Step 1 score was at the national average, and my Step 2 a little lower than that, so I don't know how favorably they'll look upon that (I didn't put so much effort in as I was just aiming to pass- FP is the least competetive field of all and I hate tests)
Then again, I don't know if I should change, as I think I went into FP for the right reasons, and it will let me do international medine (such as Doc's without borders), and wilderness medicine. But doing ER and surgery especially, are also great for international medicine. Er is probably even better for wilderness med considering they have fellowships in it.
Anyway. If you have any suggestions please let me know!
Thanks alot everyone!

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[ExtraCrispy]

Although you're now doubting FP, it doesn't sound like you're particularly sold on another specialty in its place. You're in a tough situation - I think it's crucial to ensure that you commit yourself to the field you love. However, if you're not even sure what that field is, it's difficult to draft a plan.

You mentioned the scholarship is two years - could you commit yourself to FP for the next two years, and decide based upon that experience whether or not to continue with it? It would give you solid backing as to whether or not FP can grant you the type of life you want, and if you decide it's not for you, you'll have evidence to show why another field might suit you better. After you finish the scholarship and get your license, you could always moonlight in the ED to gain more experience with EM and make an educated decision. After that, why not go ahead and apply for another residency, EM or whatever you think suits you? I know of several residents who completed an entire pediatric or medicine residency, only to decide they wanted to go into something else - they applied for another residency altogether after finishing their first. One is now in EM, another in Surgery, and a third in Interventional Rads.

It's pretty late in the game to change your application now - I'd go for the scholarship, and if you're still unsure after two years you can apply elsewhere.

 

[2ndyear]

A couple of thoughts. You like surgery, but surgery isn't on your list of approved specialties. OB/Gyn is the closest you're going to get to being a surgeon. You can always specialize in Gyn-Onc and be a hard core surgeon if that's your gig, or MFM, or Fertilization and deal much less with general OB issues. I'm not sure how NHSC looks upon fellowships though.

Med/Peds seems like an option, again I'm not sure if it's approved by NHSC, but it's more in-depth than FP with PICU and NICU rotations. You could be a super hospitalist, cover every single patient in house, imagine that.

Medicine with the 1-2 yr ICU fellowship could be an option.

You've really got to look beyond the specialties right now and consider what kind of career and/or job you want. If you really want an international 'doc without borders' gig then maybe FP is the right choice. Take the scholarship, get through the residency and learn a lot, then go and practice for people who will really appreciate your care. If staying stateside and raising a family and having relatively normal hours are more your thing then FP can do that as well, as can being a hospitalist from IM (or FP I guess), or work at an urgent care.

Also realize that it's normal to have a little 'buyer's remorse' when you finally do decide on a specialty. Your career is what you make of it AFTER residency. Many residencies can get you to the same end point, especially in primary care.

 

[GoodMonkey]

seems to me you like a little bit of everything (i.e. a specialty of breadth, not of depth) ... and FP is a good place for people like that. a little bit of really sick, a little bit of really healthy, a bit of imaging, a bit of labs, a bit of procedures, a bit of counseling. men/women/adults/kids, ob and geriatrics ... you get my picture. i'm kinda similar - like a bit of just about everything and have the ADHD personality and attention span. however, the continuity doesn't interest me so much and i like acuity and a fast pace ... i'm leaning EM. if i were you - i'd take the scholarship, put in your required time, re-evaluate. *shrug* sounds like a pretty good deal, especially if you're still young.

a little bit of everything + continuity (+ good working hours) => FP
a little bit of everything + no real continuity (except the repeat ODers) => EM

just my $0.02