Help! I have less than 0 idea what specialty

[Bubbles970]

M3 at the end of clinical rotations, and I'm getting a bit anxious not knowing what I want to do. I'd appreciate some advice.

Non-negotiables:
-Not surgery...not surgery (think Harry potter and his aversion to Slytherin lol). Small office procedures are fine, but I don't like the OR and have very little interest in being in a field where the OR is a large part.
-Having time off is important to me--I don't want to be stuck in the hospital all day, all weekends, etc. It doesn't have to necessarily be ROAD specialty, but I value time off for sure.

Basics about me:
-I value autonomy; that is, I like to be in control of the whole care of my patient from start to finish. I'm not a big fan of consulting other specialties/practices. However, I don't mind being the person who is consulted, if that makes sense
-This is really weird, but I guess being an ambivert, I'm perfectly okay going a day without talking to people, or talking to people all the time. That said, specialties on both ends of the spectrum (from radiology to FM) are fine by me
-I'm not really a generalist; I like honing in on a particular area or specialty.
-Specialties I'm not interested in at all: Cardiology, Pathology
-I neither like nor dislike gadgets/technology
-I neither like nor dislike research/teaching
-Money is important to me (you're lying if you say it isn't) but I'm well aware that you can make money in any field. However, I'd like to feel that my efforts are worth the salary I receive, and I know that there are different levels of satisfaction of physician compensation.

Basically I think my biggest problem is that I'm not the type of person to get super excited or passionate about a specialty (or anything really, it's not who I am), and I've found most people either don't seem to understand that mentality or they think it's because I haven't found "the field" yet. Well, I'm almost done with rotations, still haven't found "the field" and am worried that I'll make a poor decision because of this. I'm hoping this is where the lovely folks of SDN come in, and I would appreciate some honest advice/feedback--I've already done the "ask my dean, ask my parents, ask my mentors, read up all 120 specialties on the CIM, do the personality quizzes on UVA's site, etc. etc."

Also of importance--I really don't care WHERE I go as long as I get into said specialty, and yes, this applies for both more competitive and less competitive specialties. Note that I'm not offering up my stats because I don't want people's opinions to be based on my stats--for example, I don't want people to knock things out or put things higher on my list based on the stats. Let me put it this way--my stats won't knock me out of a school, but they won't make me a surefire bet. I'm quite average in all regards.

Thanks!

---

Members don't see this ad.

 

[theonlytycrane]

Do you have any interests outside of medicine that can help with a place to start? Or are you just a big general blob.

 

[Bubbles970]

Er, not sure it'll help at all but I can provide some of my interests. I'm a nerd, so reading, writing, gaming. I like traveling to different places, really love learning about history and visiting museums of almost any sort though (I like learning outside of just the medical context). I sort of jump from hobby to hobby and I'm not really a master of anything

 

[operaman]

I'm trying to think of something but I'm running into this wall: nowhere do you tell us anything you like.

Lots of +/- statements, you like money, you like free time, but nothing about anything you like in any field of medicine. I know it's sometimes easier to know what you don't want to do, but any inkling of what you like, or a story about some clinical experience you enjoyed would go a long way.

Some things you've said are contradictory, such as wanted to be involved from start to finish, but not wanting to be a generalist. Surgical subs are basically the only place you could find this outside of a more generalist field, but you ruled out the OR.

Barring any data points on things you actually like, I would say go for things that will maximize time away from work and still pay decently well.
1) Dermatology
2) Hospital medicine doing a week on/week off model
3) PM&R

Ok you posted some interests while I was typing this so maybe a little change up:
1) EM --- definitely jack of all trades. You're involved from the start to finish while they're in the ED, but you're not slaving away getting them discharged back to their SNF a week later either. This tends to be a nice fit for people who have lots of interests, get bored easily, value their time off. There's something to be said for never ever being on call and never ever taking a pager home with you.
2) Derm -- still arguably the best money:lifestyle ratio in medicine, assuming you have any interest in the area. Definitely pretty chill. I think that before I graduate, I want to find a reason for a stat intraop derm consult for the sheer joy of watching them try to find the OR.
3) Rads, diagnostic vs IR -- nice lifestyle and money, you get a decent amount of interaction with other physicians but maybe less so with patients.

 

[ACSurgeon]

Psych

IM with fellowship training.

Both can pay well, you’ll be an expert in a field, and won’t be in the OR.

 

[mvenus929]

What is the structure of your third year? Most all schools will do some time in surgery, IM, Peds, OB, and Psych, but some others allow for electives or surgical specialties in third year. What have you had exposure to and how did you like it?

 

[Bubbles970]

@operaman, haha you definitely hit upon the three things I was already thinking about. also yes, good point about not listing stuff i like--i'll remedy that now. I was hoping that people could give me suggestions without repeating things I like which is why I didn't say it the first time around.

I really enjoyed learning about dermatology and rheumatology in my preclinical years and while I didn't get to do a clinical rotation focusing on either one, I think conditions in both fields are pretty cool. Derm is something I have a solid interest in, but I'm not the most competitive candidate, so I didn't want to get my hopes up or anything, y'know?

I really liked my short 2 week EM course, and I do like jumping from thing to thing and getting to do little things with my hands but not big OR surgeries. The one big thing that's seriously made me rethink EM was the fact that I'm not the best under pressure (I don't necessarily freak out, but I'm not "cool as a cucumber")

I also really liked my GI unit in preclinicals; however, I think the practical reality of being faced with people's poop was a bit off-putting to me.

I thought ophtho was pretty cool too, and find diseases of the eye fascinating...but again downside is I'm not the most competitive candidate, and just the way my schedule works, I won't have an opportunity to do any shadowing/rotation before having to make my choice and I don't want to blindly jump into this (yes I'm kicking myself for not doing this earlier, I know, but I can't change anything now).

Finally, neuro seems like something I might be interested in--I like the long physical exams, the fact that the field is so rapidly evolving, and the number of options that are opening up, but I haven't done my rotation in it, and I won't have done it until it's too late for me to get the AI's that I want. Also, it's not necessarily that I didn't like neuroanatomy, but I just never felt I was very good at it/never had a strong grasp of the material so I didn't know if it was meant for me?

 

[Bubbles970]

@mvenus929, in addition to the above about what I've enjoyed, I also really liked OBGYN except being in the OR for C-sections. Like I just felt super sweaty, miserable, passed out during one for reasons unknown to everyone including myself so unfortunately I decided not OB/anything with an OR.

I've done pretty much every rotation except Neuro at this point. Done the main clinical cores--surgery (with 2 week EM elective), FM, IM, Peds, OB, Psych

 

[ParallelLines]

Interventional Pain Medicine. Fellowship done off of either Anesthesiology or PM&R.

Lots of clinic with decent amount of procedures sprinkled in like joint injections and epidurals. The more complicated spine injections will have you in an "OR"-esque setting, but the procedures are relatively quick and there's no cutting involved.

 

[precisiongraphic]

@mvenus929,

I've done pretty much every rotation except Neuro at this point. Done the main clinical cores--surgery (with 2 week EM elective), FM, IM, Peds, OB, Psych

What about trying to talk to some practicing neurologists and get in some shadow/clinical time?

 

[Karmapaymentplan]

Psych? Autonomy, possibility of private cash practice, talking to people, can still do some very basic IM with comorbid patients, great lifestyle, reasonable pay.

 

[operaman]

@operaman, haha you definitely hit upon the three things I was already thinking about. also yes, good point about not listing stuff i like--i'll remedy that now. I was hoping that people could give me suggestions without repeating things I like which is why I didn't say it the first time around.

I really enjoyed learning about dermatology and rheumatology in my preclinical years and while I didn't get to do a clinical rotation focusing on either one, I think conditions in both fields are pretty cool. Derm is something I have a solid interest in, but I'm not the most competitive candidate, so I didn't want to get my hopes up or anything, y'know?

I really liked my short 2 week EM course, and I do like jumping from thing to thing and getting to do little things with my hands but not big OR surgeries. The one big thing that's seriously made me rethink EM was the fact that I'm not the best under pressure (I don't necessarily freak out, but I'm not "cool as a cucumber")

I also really liked my GI unit in preclinicals; however, I think the practical reality of being faced with people's poop was a bit off-putting to me.

I thought ophtho was pretty cool too, and find diseases of the eye fascinating...but again downside is I'm not the most competitive candidate, and just the way my schedule works, I won't have an opportunity to do any shadowing/rotation before having to make my choice and I don't want to blindly jump into this (yes I'm kicking myself for not doing this earlier, I know, but I can't change anything now).

Finally, neuro seems like something I might be interested in--I like the long physical exams, the fact that the field is so rapidly evolving, and the number of options that are opening up, but I haven't done my rotation in it, and I won't have done it until it's too late for me to get the AI's that I want. Also, it's not necessarily that I didn't like neuroanatomy, but I just never felt I was very good at it/never had a strong grasp of the material so I didn't know if it was meant for me?

I thought about putting Ophtho but left it off because it’s really a surgical field. That said, if you maybe don’t dislike the OR as much as you think, it looks like a really fun field. I never got to do it either, but have randomly been able to scrub a couple small procedures with our Ophtho staff when the stars aligned and they were fun.

You don’t want to do neuro. I know that’s a stretch for someone who has never met you to say, but I think the day to day reality of the field is not what you’re looking for. Friends of mine who did it really really loved it and were willing to slog through the miserable parts. It’s kinda like surgery in that way - we tolerate the inherent drawbacks of surgery as a field because we really like operating and the fun parts that come with it.

Anesthesia is another one I didn’t mention but another poster did. It has a nice variety, good lifestyle, varied practice options.

In the end you might want to see what you can do to make deem happen. Talk to the people at your school and see where you stand and what it would take. My impression is that it’s like the surgical subs in that research will be very important. It’s january now, and I’ve seen people churn out 5+ publications before eras is due in September. Obviously that’s a ton of work doable. How far from competitive are you?

I’d keep EM on the table too. While not my field, I’ve rotated through there and spend a decent chunk of my call nights in there. I’m not sure if coolness under pressure is as essential as an ability to multitask and work efficiently. Maybe that’s what you meant by cool under pressure to begin with, but it does seem like tv and movies give a radically different picture of the ED and make every encounter look like a life or death seconds count sort of thing and that just doesn’t seem to be the case. When someone is sick enough, the decisions become very algorithmic and your team just does it by the book. Other times all hell breaks loose and everyone is freaked out. I worry a lot more about the nonchalant cool guy than I do the guy freaking out.

More often I see the ED staff carrying a long list of their patients plus whatever was signed out to them from the last shift, nurses frequently coming around with concerns, fielding multiple consultants like me, having to drop it all when a big trauma comes in and then play catch up, and always with 30ish or more people in the waiting room waiting for a bed to open up. There’s definitely a high stress and pressure to it, and people that do it really thrive on this atmosphere. You’re definitely never bored! It’s become a competitive field too, though not yet to the extremes of derm and the like.

 

[ConfusedChemist]

Neurology? That, or radiology.

 

[togaedere]

I have no idea how to articulate this but you sound like a nephrologist to me.

Like being consulted, you’re a nerd, you want to make decent money. I dunno something just struck me as nephro.

M3 at the end of clinical rotations, and I'm getting a bit anxious not knowing what I want to do. I'd appreciate some advice.

Non-negotiables:
-Not surgery...not surgery (think Harry potter and his aversion to Slytherin lol). Small office procedures are fine, but I don't like the OR and have very little interest in being in a field where the OR is a large part.
-Having time off is important to me--I don't want to be stuck in the hospital all day, all weekends, etc. It doesn't have to necessarily be ROAD specialty, but I value time off for sure.

Basics about me:
-I value autonomy; that is, I like to be in control of the whole care of my patient from start to finish. I'm not a big fan of consulting other specialties/practices. However, I don't mind being the person who is consulted, if that makes sense
-This is really weird, but I guess being an ambivert, I'm perfectly okay going a day without talking to people, or talking to people all the time. That said, specialties on both ends of the spectrum (from radiology to FM) are fine by me
-I'm not really a generalist; I like honing in on a particular area or specialty.
-Specialties I'm not interested in at all: Cardiology, Pathology
-I neither like nor dislike gadgets/technology
-I neither like nor dislike research/teaching
-Money is important to me (you're lying if you say it isn't) but I'm well aware that you can make money in any field. However, I'd like to feel that my efforts are worth the salary I receive, and I know that there are different levels of satisfaction of physician compensation.

Basically I think my biggest problem is that I'm not the type of person to get super excited or passionate about a specialty (or anything really, it's not who I am), and I've found most people either don't seem to understand that mentality or they think it's because I haven't found "the field" yet. Well, I'm almost done with rotations, still haven't found "the field" and am worried that I'll make a poor decision because of this. I'm hoping this is where the lovely folks of SDN come in, and I would appreciate some honest advice/feedback--I've already done the "ask my dean, ask my parents, ask my mentors, read up all 120 specialties on the CIM, do the personality quizzes on UVA's site, etc. etc."

Also of importance--I really don't care WHERE I go as long as I get into said specialty, and yes, this applies for both more competitive and less competitive specialties. Note that I'm not offering up my stats because I don't want people's opinions to be based on my stats--for example, I don't want people to knock things out or put things higher on my list based on the stats. Let me put it this way--my stats won't knock me out of a school, but they won't make me a surefire bet. I'm quite average in all regards.

Thanks!

 

[Psai]

I have no idea how to articulate this but you sound like a nephrologist to me.

Like being consulted, you’re a nerd, you want to make decent money. I dunno something just struck me as nephro.

Decent money and nephro don't belong in the same sentence

 

[DrWhozits]

Some one mentioned IM + Fellowship, but no one has said Heme/Onc.

Sounds like it checks most if not all of your boxes.

 

[prettyNURSEtoMD]

People are mentioning EM, but they consult everybody on admissions. Although 60% of volume is fast-track, but there is heavy consulting. He/She stated that he doesn't want to consult. You have an acute abdomen, consult surgery. Stroke, consult neuro, Regular admission, consult hospital medicine. STEMI, fracture, consult, consult, etc. So I mean, in regards to every thing else he mentions, as far as autonomy, boredom, not really a master of anything (sorry really not quoting verbatim), but if he really hates talking to people, and want's start to finish, EM doesn't seem to be a good fit. You'll start but you won't finish. But time off, shift work, leave the patient at the door. This is where you'll end up. You come to work, work your said shift and go home. I've seen residents truly flip their shi+ when a code comes in, or they need to drop an IJ, or that random drop off GSW, things like that, but they aren't squeamish. There is a difference. It does get heightened but they can all hang. But if you're the medical student in the corner covering their face with their hands, or can't compress on this CPR because blood is coming out the ETT, because I've seen this, or it's just "too much going on', then it may not be for you. Just some things to think about as as EM goes. If you can handle consults, variety of patients, want shift work and time off, not a lot of continuity, then yeah, but if you REALLY value no consults, start to finish, generalist type, then you need to keep looking. My own opinion, be a hospitalist, do IM and fellowship later should you find something you like. I really hope you find something. But this entire post sounds like one of those job questionnaires to see if you're a good fit "5 strongly agree, 3 neither dislike nor like"...

 

[doc05]

RADIOLOGY.


You're welcome.

 

[Gray Fox]

People are mentioning EM, but they consult everybody on admissions. Although 60% of volume is fast-track, but there is heavy consulting. He/She stated that he doesn't want to consult. You have an acute abdomen, consult surgery. Stroke, consult neuro, Regular admission, consult hospital medicine. STEMI, fracture, consult, consult, etc. So I mean, in regards to every thing else he mentions, as far as autonomy, boredom, not really a master of anything (sorry really not quoting verbatim), but if he really hates talking to people, and want's start to finish, EM doesn't seem to be a good fit. You'll start but you won't finish. But time off, shift work, leave the patient at the door. This is where you'll end up. You come to work, work your said shift and go home. I've seen residents truly flip their shi+ when a code comes in, or they need to drop an IJ, or that random drop off GSW, things like that, but they aren't squeamish. There is a difference. It does get heightened but they can all hang. But if you're the medical student in the corner covering their face with their hands, or can't compress on this CPR because blood is coming out the ETT, because I've seen this, or it's just "too much going on', then it may not be for you. Just some things to think about as as EM goes. If you can handle consults, variety of patients, want shift work and time off, not a lot of continuity, then yeah, but if you REALLY value no consults, start to finish, generalist type, then you need to keep looking. My own opinion, be a hospitalist, do IM and fellowship later should you find something you like. I really hope you find something. But this entire post sounds like one of those job questionnaires to see if you're a good fit "5 strongly agree, 3 neither dislike nor like"...

The first half of this is a pretty inaccurate description of EM. How much you consult is very program specific. EM docs are masters of resuscitation and stabilization of undifferentiated medical and trauma train wrecks that come through the bay. We do this better than any other speciality and make good money (per hour) doing it. If you want, you can sub-specialize in toxicology, critical care, etc.

I agree with the 2nd half. You can't do EM if you need hand holding, afraid to get (really) dirty, or don't like to interact/talk with all different kinds of people on a regular basis.

OP, you're kinda picky, but overall, sounds like derm. I personally hate derm (would rather jump into a pool of scalding acid), because I find it boring and don't jive with the (bougie) derm culture, but maybe its for you.

Edit: read more of thread. Rheum, neuro, and psych are good fields for you too based on description/competitiveness. Forget EM. Need to be cucumber cool.

 

[prettyNURSEtoMD]

The first half of this is a pretty inaccurate description of EM. How much you consult is very program specific. EM docs are masters of resuscitation and stabilization of undifferentiated medical and trauma train wrecks that come through the bay. We do this better than any other speciality and make good money (per hour) doing it. If you want, you can sub-specialize in toxicology, critical care, etc.

I agree with the 2nd half. You can't do EM if you need hand holding, afraid to get (really) dirty, or don't like to interact/talk with all different kinds of people on a regular basis.

OP, you're kinda picky, but overall, sounds like derm. I personally hate derm (would rather jump into a pool of scalding acid), because I find it boring and don't jive with the (bougie) derm culture, but maybe its for you.

Edit: read more of thread. Rheum, neuro, and psych are good fields for you too based on description/competitiveness. Forget EM. Need to be cucumber cool.

Well, this is just what I see at my hospitals that I work at, and my friends who are EM attendings, they consult all the time. So, yeah I'll say it might be hospital specific, but we are a huge receiving hospital, but I wouldn't say its completely inaccurate, meaning what I said is not true. I mean, I didn't say they don't resuscitate or stabilize, but once you do are they not going to the unit? That's what I'm saying in regards to consulting for admission purposes. Not, consulting as in "we need help because we can't figure out what's going on". If that's what you meant! I may have misunderstood and maybe OP when he meant "consulting".

 

[Gray Fox]

Well, this is just what I see at my hospitals that I work at, and my friends who are EM attendings, they consult all the time. So, yeah I'll say it might be hospital specific, but we are a huge receiving hospital, but I wouldn't say its completely inaccurate, meaning what I said is not true. I mean, I didn't say they don't resuscitate or stabilize, but once you do are they not going to the unit? That's what I'm saying in regards to consulting for admission purposes. Not, consulting as in "we need help because we can't figure out what's going on". If that's what you meant! I may have misunderstood and maybe OP when he meant "consulting".

We don't "always consult everybody on admissions". If you have an admission and you don't have to consult, you just admit to the floor. You said EM docs aren't masters of anything, but you're wrong, we are the best at acute resuscitation and stabilization. And I'm telling you, it is very program specific. An EM doc has to be much more independent in the community, where he or she isn't surrounded by an army of in-house specialists. No offense, but if your EM attending friends have to consult everyone all the time, they sound like lousy EM docs, and I would hate to train at that shop. Lastly, I don't see any fast-track patients--they are seen by the mid-levels. Everyone I see is Level 3 or lower.

 

[prettyNURSEtoMD]

We don't "always consult everybody on admissions". If you have an admission and you don't have to consult, you just admit to the floor. You said EM docs aren't masters of anything, but you're wrong, we are the best at acute resuscitation and stabilization. And I'm telling you, it is very program specific. An EM doc has to be much more independent in the community, where he or she isn't surrounded by an army of in-house specialists. No offense, but if your EM attending friends have to consult everyone all the time, they sound like lousy EM docs, and I would hate to train at that shop. Lastly, I don't see any fast-track patients--they are seen by the mid-levels. Everyone I see is Level 3 or lower.

Oh, well you sir, (or madam) are very different than any provider I've worked with or know. I have NEVER seen an EM doctor admit to the floor w/o a consult, because, I have personally paged those calls myself on more occasion than one. And for our vertical flow patients, a lot of our docs will see them especially out in triage. The docs I work with will sign up for FT patients ALL the time. APP or not. I'm not saying what you have experienced doesn't happen, just saying what I'm used to. Our APPs will see 4s and 5s, yeah, but if we pull to full, the docs will most definitely see them. I work at two very large hospitals down south both Level 1s, and this is what I see time and time again. I would love to see how it works where you work at, sounds very different than what we do and pretty interesting! And as far as "master of nothing", I think that was taken out of context fwiw, but I feel you on what you're saying! Either way, OP has lots of info from people on this board, so hopefully h/she can make a good decision!!

 

[TypeADissection]

You have "I'm a Hospitalist" written all over your forehead. Congratulations. You're going to do 7 days on and have 7 days off and make bank. You will enjoy your life outside the hospital and begin to fill up your passport with stamps from countries I'll never see. You will realize before many other bright-eyed bushy-tailed med students that this is just a job and nothing more. You will go to your kids games, coach them, watch them grow in person instead of through pictures while on call in the hospital. Work won't get you super-excited but that's never what you were looking for anyway. You're going to introduce yourself as Bubbles and live the rest of your life in peace. Cheers.

 

[CherryRedDracul]

RADIOLOGY.


You're welcome.

This and partly because it's my field. You don't have to talk to as many patients, but you will be talking to a lot of other clinicians especially if you're on call.

 

[NavyDoc23]

My first thought for you was Radiology as well. You don’t consult anyone, people are consulting you. You are a specialist, but if you’re in private practice, you will do everything. You can do short procedures in radiology. You work hard, but there’s a good amount of time off and the money is good, too.

 

[J ROD]

Well, I can add my thoughts. I would look into PM&R, Neuro, Rads, Psych, perhaps IM subs - Heme/Onc, (Rheum, Endo, Nephro money are not great). Depending on money, Rads would be the best choice for you. Neuro is my deep sleeper for you. I ruled out Derm, Optho since you said you are not that competitive. Consider Anesthesia. It hits many things you mention except OR. EM does not sound like you to me overall.

 

[AsianPersuasion]

I'd vote for IM with a fellowship.

 

[jhamaican]

Gastroenterology is what you need in your life.