Help I don't know what I want to do!

[misery]

So I'm in Oct of my fourth year and I haven't got a clue what I want to do with my life. Is anyone else in this position?

I have GREAT grades and board scores but that doesn't mean a darn thing if I don't know what I want to do. I have thought about a prelim surgery year, a transitional year, or just going into IM or EM. I'm a non-trad student and just can't stand the thought of loosing a year. I have letters for both IM and EM. What do I do? I'm on IM right now and when I'm in the ER I love it, then when I'm on the wards I love it, then when I'm home I think about anesthesia. I don't have the option of doing any other electives until January. I have done one away in IM but none in EM. Sorry for the rambling I'm just starting to freak

Any suggestions?

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[Winged Scapula]

Yes.

Do. Not. Do. A. Prelim. Surgery. Year.

Seriously, if you cannot decide why make the year painful and potentially unuseful (ie, there are more specialties you can get into with a Prelim Med or TY)? If you have great grades and USMLEs then you should be competitive for TY...however, it is getting late for applications so for competitive positions like TY you probably need to apply sooner rather than later.

I had a friend who couldn't decide between IM with a PULM CC fellowship, pathology or psychiatry. She did some more final year electives, did a TY and then went into psychiatry. There is no shame in not knowing what you want to do.

 

[edmadison]

Have you thought about critical care? You can do this through IM or EM. Might give you the best of both worlds.

Ed

 

[dragonfly99]

This is a problem with your medical training system. Often, I think we'd be better off if we did as some of the European countries do, where everybody has to do a general internship (though I think they have some general areas of concentration) before declaring a specialty they want to pursue.

In your situation, I'd go for some intensive counseling with your career advising office. Also, consider applying to a whole bunch of transitional years and IM prelim years. Go for the good/prestigious places for the medicine prelim years, since you are a strong candidate. Alternately, just pick something and go with it. ER is a pretty good specialty b/c they have variety, good hours, paid well, etc. IM is often picked by people who don't know what they want to do, but remember you'll eventually have to pick something, even if you delay this by picking IM...unless you want to stay in general IM, which if you read most polls, etc. has a high rate of discontent among docs out in the "free world" practicing it. I agree with not doing a surgical prelim year...they'll just work you and work you and unless you are pretty sure you want to be a surgeon I don't see the point in doing it...you'll not have time to go on interviews while doing it either I don't think. You'd probably run into this problem with IM prelim year as well, though. For that reason, I think I'd either
a) just pick something you like a lot and go with it, realizing that all choices in life involve giving up other opportunities
or
b) go hard for a transitional year, if that fails then match into the best IM prelim year you can find

 

[yeasterbunny]

b) go hard for a transitional year, if that fails then match into the best IM prelim year you can find

I disagree in part to this; generally I recommend the TY as it is easier lifestyle-wise without really sacrificing your education IMHO, but this is the one type of situation in which I think it may be reasonable to seek out a PY over a TY. It sounds to me like you may very well like IM, and if that ends up being the case you can continue on at the same program or go somewhere else as a PGY-2, but if you have done a TY and decide to go to IM you may well have to repeat your intern year.

On a side note, if you are drawn between IM and ER, have you considered being a hospitalist? That would draw on some of the things people like about both fields.

 

[dragonfly99]

OK,
that actually makes sense.

I only recommend the transitional year if you want to plan to go into something that will accept a transitional year (i.e. radiology, and perhaps optho...what other specialties accept the transitional year?).

If someone is torn between ER and IM they should probably do ER because it's a better lifestyle and less hours, with more money...if you are truly on the fence. I would never overtly discourage someone from doing IM since I am an IM doc, but I do think there are quite a few unhappy people in IM who went into it just because they "didn't know what they wanted to do". Those are the folks who are cursing themselves having chosen this...I think those of us who consciously decided to do it (not that there isn't always some tiny shred of doubt, as with most all choices in life) are pretty happy with it, but there are quite a few unhappy people in IM and I think a lot of them are the ones who either went into it b/c they had few other options, or just did it b/c they didn't know what they wanted to do...

If someone is truly a glutton for punishment, there are combined ER/IM residencies, but I wouldn't personally go that route. Just pick one and go with it...5 years of residency in IM + ER is too long, IMHO.

 

[hippiedoc13]

Another option, if you really do have it narrowed down to EM vs IM, is to apply to programs in both specialties, perhaps as well as a bunch of prelim programs, and see if your decision becomes clearer once you visit these programs and really imagine yourself as a resident in these specialties. This may also buy you some time to do a few more clinical rotations in your areas of interest and see if that clarifies your choice at all. There are pros and cons to this approach (some major cons), and of course it would be expensive.

On the other hand, if you are saying that right now you could go with IM or EM, but you think there might be other specialties out there that you would strongly consider as well (ie you really don't know what you want to do at all), I would second WS & dragonfly's excellent suggestion to go for a prelim medicine year. But in the meantime stack up the rest of your 4th year with some solid rotations that will really help you explore/narrow down what sort of career you'd like to have.

It's a tough call. There are advantages and disadvantages to every approach, gotta think about it from all angles. Best of luck to you, let us know how things turn out.

 

[yeasterbunny]

...what other specialties accept the transitional year?

radiology, ophtho, anesthesia, derm, rad onc, PM&R, nuc med (I think)

 

[dragonfly99]

nuclear med isn't a real specialty, because unless you do radiology first, I hear it's pretty much useless.

There are IMG's stuck in that specialty who never completed a residency (other than that one) who can't get a job. Or so I hear...

 

[financeguru09]

Stick with IM and take the Air Force Financial assistance program to give you an extra $67000 per year, on top of the residency pay. Then, as a physician in the AF, you will have to opportunity to train into different areas through AF residencies.

 

[dragonfly99]

Don't join the military for the money...only do it if you REALLY want to be in the military, and/or make a career out of the military. Financially you can do fine in the private sector or working in a public clinic when you get finished with your training.

One thing that nobody has mentioned about a medicine prelim year is that you will likely spend most all of your year in the medicine dept., doing medicine rotations (i.e. ward and medical ICU) with maybe 1 clinic month or so in medicine clinics. You may if you are lucky have 1 ER month. That's the way it was @my medicine program anyhow (I had no ER, just 10.5 months MICU and wards, and 1 month clinic). So if you are looking for your medicine prelim year to help you decide what you want to do, it probably won't. Still, it would buy you time in the sense that you aren't committed to a full categorical medicine program. It would give you time (i.e. all of 4th year potentially) to figure out what you really want to do.

A transitional year, on the other hand, would very likely be cushier (i.e. less call and wards months) plus let you rotate through different areas. However, as has been mentioned above, it wouldn't count as a "1st year"/prelim year for some specialties - internal med and neurology, for example, wouldn't accept all the months so they'd make you repeat at least part of a year if you decided you wanted to do those specialties.

 

[dragonfly99]

Another point of view would be that if you are torn between ER and internal med, you should just go for ER. Rationalie: If you later change your mind (say, while you are an intern), it would be pretty easy to switch into internal med from ER, but not as easy to do the opposite. At any rate, if you have good grades and board scores, etc., it would be fairly easy to do a switch from one to the other if you ended up not liking the one you picked.