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MD & DO Help deciding on back up plan/specialty

Scrubs101

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Alright so I’m 100% sold on applying to a surgical sub, however given the whole COVID situation and with me being a DO I’ve been heavily considering applying a back-up speciality/“parallel plan”. I’m currently between DR (with the hopes of going IR or something procedure heavy) or GS (with the hopes of subspecializing).

(I understand some think that admitting to applying a backup isnt considered kosher and people may question commitment to the primary specialty. I’m curious to hear your thoughts on if applying a back up will do more harm than good for me as well. As of right now my advisor is recommending it and so I’m planning on at least setting myself up for a backup and if I feel good about my audition rotation coming up might just pull the plug on the idea, but better to be prepared and not need to be than not be prepared at all.)

GS:

I love being in the OR, no other rotation or setting has ever even come close to giving me the same thrill that I got on my surgery rotation in the OR, mid-amputation, with the attending bumping some dope tunes.

The only clinic I’ve ever enjoyed are clinic visits related to my primary specialty of choice. Otherwise I’m just not a big fan. I def prefer hospital time > clinic time.

I love anatomy, favorite class was anatomy, learned best by being in the anatomy lab, taught anatomy, have done anatomy related research, etc. But I don’t have much of a passion for GI anatomy and dont really enjoy the medical management side of GS. I could see myself enjoying a lot of the fellowship options off of GS though.

My GS rotation was pretty chill, a handful of 5a-7p days but mostly 5a-3/4 so my idea of the lifestyle may be very skewed. But I left that rotation wanting more, so as long as I dont end up at a very malignant program I’m not overly concerned about surviving residency as long as I can build a semi-decent lifestyle as an attending.
I already have the letters arranged for a GS app.

DR:

We get a 2 week core DR rotation so my experience has been limited. But I enjoy being able to appreciate the anatomy, I’ll take it as a decent 2nd to appreciating the anatomy directly.

I like the environment of the reading room. I’m weird and enjoy doing case based questions and would consider it decently fun, so doing reads and putting together the puzzle is still quite enjoyable to me. I love when the radiologists get excited about a neat finding and make sure to let the other radiologists and med students in the room see it.

I like new/upcoming advancements in technology, working at a computer most of the day doesnt bother me, and the reading room felt fast pace yet peaceful at the same time (but this is a med students perspective that rads doc coulda been exploding on the inside over some issues and unless they verbalized it i probably wouldnt know).

I love the intermittent breaks to go around the hospital and do some procedures (we did 90% DR 10% minor IR stuff). But I definitely enjoyed the procedures more than reading, and while I didn’t see too much of the more intense IR stuff from what Ive seen in videos online I think I’d really enjoy it. Plus vascular anatomy is probably my second fav after my primary sub.

I like the flexibility of the DR/IR combo, can do whatever % mix of procedures and reads, and tele is always an option down the road if need be (though it definitely would not be my first choice in practice set up). IR has the potential to give back the adrenaline thrill that DR doesn’t provide, but there’s obviously always the chance I dont match into the fellowship I want (same issue in GS tho).

While the “worse” lifestyle of GS didn’t bother me I can still very much appreciate the benefit of more free time as I have some more time/energy intensive hobbies I’d like to continue as I get older. Part of me feels the “If I can’t have my primary specialty of choice maybe I should just go for the best lifestyle possible”, as long as I still find that specialty moderately enjoyable. I’d be a ski bum full time if it could pay off my loans some how, so I can absolutely appreciate that giving up on the thrill of the OR could be potentially made up by more time doing things I enjoy.

Its possible my view of rads lifestyle may be skewed as well, as it seems the docs i worked with had it made. No call, decent hours, pure generalist sees/does everything rads (community hospital), etc.

Still would need a DR letter.

My app: scores/grades are competitive
Research: 4-5pubs in anatomy subjects, no major journals or anything. 1 is vascular related.
Lots of anatomy related work experiences, feel like i can spin this surgically or radiologically.

Need advice on:

Deciding between the two
Will a backup hurt me?
Whats the accepted strategy for applying a backup?


Thanks in advanced for any help y’all may be able to offer.
 
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theonlytycrane

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If lifestyle is more important to you than anything (if you'd be willing to go DR over your surgical sub), then I would consider DR. Otherwise I feel like if you don't match your surgical sub, you'll be sad in DR and miss the OR.
 
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Schwifty

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Ive seen a decent amount of people who applied to ortho apply to DR as a backup or apply to DR the next cycle if they didn't match, not sure if you are going ortho but it seems like a lot of ortho people would choose DR over GS
 
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Scrubs101

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If lifestyle is more important to you than anything (if you'd be willing to go DR over your surgical sub), then I would consider DR. Otherwise I feel like if you don't match your surgical sub, you'll be sad in DR and miss the OR.
I feel that, with COVID going on recently and having been off of rotations for 3-4months I can definitely say I eventually got bored of the limited hobbies I could do and that I feel much more fulfilled with a balance between work and life. So I wouldn't say I value one over the other, I just want to be able to enjoy both. If that makes sense. I have FOMO about the OR and FOMO about lifestyle, but when it comes to the surg sub I'm decently confident I'd be able to find my balance. I just don't know enough about DR/GS to say the same I guess.
 

Scrubs101

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Ive seen a decent amount of people who applied to ortho apply to DR as a backup or apply to DR the next cycle if they didn't match, not sure if you are going ortho but it seems like a lot of ortho people would choose DR over GS
Definitely something I've heard as well, DR and ER seem to be more common than GS as a backup for the aspiring orthopods (anecdotally) and I'm quite curious as to why this might be.
 
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Scrubs101

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Are DR and GS Good backups for DOs? I thought DOs had a 50% gen surg match rate
Depends on your app. If you're going by NRMP 2018 Osteopathic data alone (which definitely does not paint the whole picture).

General match statistics show ortho 23% GS 50% DR 81%. If you look at the "probability of matching" charts by score >.90 chance exists on the chart for GS and DR but ortho maxes out at like .6 .

As a general rule of thumb DR and GS are currently generally attainable as a DO with >average stats. Surg subs can be a mess regardless of stats on the DO side.
 
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Schwifty

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Definitely something I've heard as well, DR and ER seem to be more common than GS as a backup for the aspiring orthopods (anecdotally) and I'm quite curious as to why this might be.
I asked the same thing and from what I was told is that they like DR because its anatomy heavy and they can still do procedures in IR. As for why not GS, not sure
 
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theonlytycrane

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From reading your post I get the vibe that you could find a way to be happy in DR. But that you love the OR. Hope you just match ortho so you can forget about the rest :)
 
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Gilakend

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Wow, this is surprising. I came in thinking ortho or EM, recently threw IR into the mix. Have exactly 0 interest in doing GS. I had no idea this combo was so common, I felt like my interests were all over the place.
 
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slowthai

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Wow, this is surprising. I came in thinking ortho or EM, recently threw IR into the mix. Have exactly 0 interest in doing GS. I had no idea this combo was so common, I felt like my interests were all over the place.

Yeah, if I couldn't do ortho for some reason, my next choice would 100% be DR, not and never GS.
 
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Neopolymath

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The procedural aspect of DR/IR will NOT satisfy a true yearning to operate. They are not the same. Only you can decide if you would rather do radiology than do GS and give up on being a surgeon (as backup). If you can't be the type of surgeon you want to be you might not want to be a surgeon at all. I get it though. Most people attracted to surgical subs don't actually like GS at all because they are only similar in the ability to do surgery in general and little else. I know several DR folks who were Ortho bound.

Ironically, I'm the opposite. I far preferred GS than ortho subject matter even though my years with my ortho bros was a lot of fun. I didn't love GS enough to put up with the lack of surgical sub benefits and negatives of surgery over radiology or anesthesiology. Obviously, that told me that I didn't NEED to be a surgeon and made the situation easier to figure out.

I think you should reach out to some more senior people to flesh out your goals. See if any of them considered other fields and why/why not they pursued them.

You need to ask yourself what you like about Ortho the most and go from there. Take a true inventory. I think operating is absolutely without a doubt the coolest thing in the world and yet the BS that GS in particular dealt with was not worth my family, cars, boat etc time and I could be 80+% happy doing something else.
 
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Scrubs101

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The procedural aspect of DR/IR will NOT satisfy a true yearning to operate. They are not the same. Only you can decide if you would rather do radiology than do GS and give up on being a surgeon (as backup). If you can't be the type of surgeon you want to be you might not want to be a surgeon at all. I get it though. Most people attracted to surgical subs don't actually like GS at all because they are only similar in the ability to do surgery in general and little else. I know several DR folks who were Ortho bound.

Ironically, I'm the opposite. I far preferred GS than ortho subject matter even though my years with my ortho bros was a lot of fun. I didn't love GS enough to put up with the lack of surgical sub benefits and negatives of surgery over radiology or anesthesiology. Obviously, that told me that I didn't NEED to be a surgeon and made the situation easier to figure out.

I think you should reach out to some more senior people to flesh out your goals. See if any of them considered other fields and why/why not they pursued them.

You need to ask yourself what you like about Ortho the most and go from there. Take a true inventory. I think operating is absolutely without a doubt the coolest thing in the world and yet the BS that GS in particular dealt with was not worth my family, cars, boat etc time and I could be 80+% happy doing something else.
Absolutely agreed, while I like the procedural work of DR/IR you are correct in that it is absolutely not the same as operating. In my mind my rotations have been ranked like this-> operating specialties > procedural base specialties > specialties that spend most of their time in the hospital > outpt based stuff. But like you said in your last paragraph it's definitely more than just operating vs not operating that goes into this decision, even though the question "can I be happy without the OR in my future" is an important one. While I think I can absolutely live a happy life without operating, the FOMO is def still there. With DR/IR I may not get as much enjoyment out of procedures (gotta throw in that I realize I'm just a med student mostly observing with an occasional suture thrown here and there and that I recognize my personal enjoyment watching a procedure is likely very different from actually doing it), I may enjoy family/hobby time enough to make up for that loss.

Congrats on being able to make that call though man, and I appreciate the advice. I'm definitely gonna reach out to some seniors to gather a more diverse and personalized view. I've got a few rotations planned that I think will help me make the call so hopefully this gets easier with more experience, still playing with the idea of avoiding a backup entirely and just nutting up in the soap if worst comes to worst as well.
 
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libertyyne

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I vote for Dr/IR as a backup, i am not sure how accessible they are during soap. The idea of soaping into medicine makes me a little worried tho.
My view is that it is not the operating that I necessarily need, its the need to do something tangible for patients with a skill is what makes procedures and surgery appealing. If i can use my hands and my mind , and problem solve everyday it provides a sense of purpose that I can not achieve by managing meds.

I would rather avoid GS because of the malignancy in training i have witnessed.
 
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Scrubs101

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I vote for Dr/IR as a backup, i am not sure how accessible they are during soap. The idea of soaping into medicine makes me a little worried tho.
My view is that it is not the operating that I necessarily need, its the need to do something tangible for patients with a skill is what makes procedures and surgery appealing. If i can use my hands and my mind , and problem solve everyday it provides a sense of purpose that I can not achieve by managing meds.

I would rather avoid GS because of the malignancy in training i have witnessed.
Fair point about soaping, the options can be hit or miss and I'd absolutely do a research year over IM/FM if those were my only options (no offense to my medicine peeps, just not for me).

Completely agree about the tangible aspects of procedures/surgeries being the most appealing factor, in addition to the (almost) immediate beneficial outcomes of some of these procedures/surgeries. While managing hypertension long term can prevent some seriously harsh consequences, it doesn't come with the immediate gratification that procedures/surgeries do.

The malignancy of some GS programs concerns me as well, and I'm not as well-tuned into the GS world to know who to avoid atm.

Curious though, with regards to NSGY do you prefer endovascular or open? (ignoring lifestyle factors that go along with the subspecialtizations)
 
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libertyyne

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Fair point about soaping, the options can be hit or miss and I'd absolutely do a research year over IM/FM if those were my only options (no offense to my medicine peeps, just not for me).

Completely agree about the tangible aspects of procedures/surgeries being the most appealing factor, in addition to the (almost) immediate beneficial outcomes of some of these procedures/surgeries. While managing hypertension long term can prevent some seriously harsh consequences, it doesn't come with the immediate gratification that procedures/surgeries do.

The malignancy of some GS programs concerns me as well, and I'm not as well-tuned into the GS world to know who to avoid atm.

Curious though, with regards to NSGY do you prefer endovascular or open? (ignoring lifestyle factors that go along with the subspecialtizations)
I find endovascular procedures more appealing at this time, although open procedures are more fun , There is no bigger rush than restoring circulation to the brain.
All in all i find procedures that have very clear outcomes immediately after to be more satisfying, like even placing and evd for hydro, or repairing a spine after trauma, or evacing an epidural.
Back surgery may improve quality of life in someone , but it may take months for the person to recieve this benefit.

Lastly minimally invasive procedures get a bad rap from the residents because they are not open and there isnt a lot of opportunity for involvement, but most of the time these procedures have equivilent or better outcomes with less post op pain / complications etc. making them better in my mind , even though the procedure isnt as exciting.
 
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DrOrthoSpineMD

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Lastly minimally invasive procedures get a bad rap from the residents because they are not open and there isnt a lot of opportunity for involvement, but most of the time these procedures have equivilent or better outcomes with less post op pain / complications etc. making them better in my mind , even though the procedure isnt as exciting.

Those Attendings learned the MIS skills somewhere and at some point in their training. Once you start doing the MIS stuff yourself you will probably like it too. Most residents dislike it until they do it. The first time I got to do an XLIF or MIS TLIF it was the coolest thing in the world. Watching it from far away was a little less exciting.
 
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Chlorini

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I say do IR/DR if ortho doesn't work out!

I jumped ship from ortho to rads in my third year. I still think ortho is great, but I couldn't commit to the crazy hours during residency. I like radiology because you can really tailor it to what you want. I'm still learning about all the cool things they can do-- I spent a bunch of time shadowing interventional MSK radiology and I saw that rads did all the bone biopsies, the sarcoma ablations, and the kyphos (which I didn't know they did--I thought ortho did these). Contrary to popular belief, interventional MSK is completed DR--->MSK fellowship.

I'm in my transitional year now, starting DR next year. If it's too isolated/not what I imagined, I like that I can switch to IR in the beginning of my third year if I want. If you decide on rads as a backup, make sure you go to a program with ESIR. My program told us they could make additional IR spots for DR residents that changed their mind; I'm sure other programs are the same.

Good luck!
 
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Scrubs101

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I say do IR/DR if ortho doesn't work out!

I jumped ship from ortho to rads in my third year. I still think ortho is great, but I couldn't commit to the crazy hours during residency. I like radiology because you can really tailor it to what you want. I'm still learning about all the cool things they can do-- I spent a bunch of time shadowing interventional MSK radiology and I saw that rads did all the bone biopsies, the sarcoma ablations, and the kyphos (which I didn't know they did--I thought ortho did these). Contrary to popular belief, interventional MSK is completed DR--->MSK fellowship.

I'm in my transitional year now, starting DR next year. If it's too isolated/not what I imagined, I like that I can switch to IR in the beginning of my third year if I want. If you decide on rads as a backup, make sure you go to a program with ESIR. My program told us they could make additional IR spots for DR residents that changed their mind; I'm sure other programs are the same.

Good luck!
Thank you! I’d never heard of inventional MSK before, but I just watched the yale ground rounds youtube video on it and it seems like a sweet gig! Do you have any resources you recommend to look into this?/Do you know how common these types of jobs are to find?
 
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Chlorini

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Thank you! I’d never heard of inventional MSK before, but I just watched the yale ground rounds youtube video on it and it seems like a sweet gig! Do you have any resources you recommend to look into this?/Do you know how common these types of jobs are to find?

I don’t unfortunately, I’m sorry. I’m still learning myself. I doubt you could do that PP though—most of the cool interventional MSK stuff is done at large academic institutions. What you can do is go to radworking.com and see what MSK/IR jobs are out there though. You’ll see that the work really varies.
 
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MavFab

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Thank you! I’d never heard of inventional MSK before, but I just watched the yale ground rounds youtube video on it and it seems like a sweet gig! Do you have any resources you recommend to look into this?/Do you know how common these types of jobs are to find?

This looks similar to interventional pain but with addition of bone biopsies and tumor ablation.
 
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libertyyne

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Are the patients evaluated by ortho and just sent to rads for the procedure? I was under the impression that radiology would also examine the patient before they did any procedures.
Its a consult service in my hospital. Rads still has to accept the patient and do a quick pre-procedure assessment/consent. But it is nothing like pain where you have longitudinal patients and clinic.
 
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MavFab

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Its a consult service in my hospital. Rads still has to accept the patient and do a quick pre-procedure assessment/consent. But it is nothing like pain where you have longitudinal patients and clinic.

Ah gotcha, that is definitely better for someone who doesn't like clinic and sounds like you are treating patients with higher acuity. Only downside I personally see is having to be employed by the hospital/work in academics. I wonder if there are any PP groups that do this.
 

libertyyne

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Ah gotcha, that is definitely better for someone who doesn't like clinic and sounds like you are treating patients with higher acuity. Only downside I personally see is having to be employed by the hospital/work in academics. I wonder if there are any PP groups that do this.
PP guys are probably reading and poking inbetween, aint no one got time for clinic when you get paid in procedure and read. Pain and MSK rads are very different specialties is the take home point , even though there might be some procedural overlap.

Not owning the disease process/patients is both a blessing and curse for rads.
 
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Chlorini

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Ah gotcha, that is definitely better for someone who doesn't like clinic and sounds like you are treating patients with higher acuity. Only downside I personally see is having to be employed by the hospital/work in academics. I wonder if there are any PP groups that do this.

Yes, that’s a big downside of rads. We rely on consults/referrals. That’s how IR lost a lot of the cardiac cases (once cards realized they could keep the patient and do the procedure themself they stopped referring out). Radiology as a whole is very aware of this and has been taking action to remedy it.

As of now, ortho is happy with their big $$ surgeries and aren’t fighting for the biopsies/more procedural stuff.

But in general, speciality cancer stuff will stay in big cities/big academic centers because there is no demand for sarcoma ablations in suburbia or rural pp groups.

I did see a lot of MSK radiologists go work for multispeciality pp groups and do arthrograms/biopsies in addition to reads. I know I plan on doing a similar mix. I want to be formally trained in either mammo or MSK and do “light” IR. The biggest demand is for the small procedures (paras/thoras/biopsies) not for the TIPS/TACE cases. If you’re someone who needs the “big stuff,” rads might not be for you. I know I get satisfaction from putting in something as small as an IV lol.
 
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