Help - Nearing end of MS3 and still don't know which speciality

[general admission]

I need some advice on this. The choice of which specialty has been nagging me throughout the whole year. I had some ideas in MS1-2, then went into third year SURE I was going to do a competitive surgical subspecialty. After rotating in it in third year, it didn't click with me. In fact, nothing has. I feel like I could be forced into anything and do fine and help people, but I'm not sure I'd be happy. I seem to change my mind once every few weeks, and get fixated on something. I've been set on like 8 different specialties throughout this year... Rads, every surgery specialty, multiple IM subspecialties, Gas, etc... If I had just stuck with something from the get go - anything - I feel like I would have been better off.

Part of me wonders if I'm just chasing prestige. I've thought about IM and then subspecialty, but then get second thoughts for reasons I feel like I shouldn't. I don't get that feeling of accomplishment that I have become something "cool" like a plastic surgeon, even though I don't think I'd like surgery as a career. How do I get over that? I suppose matching into a top IM namebrand would give me a similar feeling, but getting into one is a crapshoot.

I just can't figure this out. I feel like the opportunity of research for certain super-competitive specialties has sailed, leaving me less than comfortable with my chances. I have nagging feelings ("give surgery another shot, maybe you just had a bad experience") and feelings of telling myself to shoot for the stars while I still have a chance, not to "settle".

Where should I go from here? Should I pursue a surgical rotation in M4 to definitely see if I'd like surgery or not? I'm also not opposed taking a year off for research if it meant matching into something I eventually felt passionate about. I like clinic, I feel OK to good about the OR, I like procedures, I like challenge... I like teaching, I like research. Lifestyle is also growing in terms of "importance" to me. I'd appreciate any help.

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[Gadofosveset]

The insight you have to your decision-making process will pay off in the long run, even if it's causing you problems now.

My advice would be to keep trying things until something clicks. Try taking on more responsibility in surgery and IM to see if you actually like the practice of the field instead of just the idea of the field. As other people have mentioned, and is good advice, look at the attendings in various fields and ask yourself if you like what you see. Not the show; the show + the actual existence.

Also, consider if you have other related interests that might satisfy you if you can bring them to bear. For instance, if you really love teaching, consider a field that will allow you to work that in. Same with research, patient interaction, free clinic work, research, whatever.

Right now, specialties might seem like monoliths that you have to climb and overcome... and when you get to the top it will define you. This is only partly true. When you get to the top of the training pyramid, there's more to go; you begin personalizing your specialty after it has had the opportunity to define you a little. You don't have to remain stuck in a specialty "slot", unless you want to. Ideally, a specialty should bring out and utilize other strengths you have.

 

[JP2740]

What's your step 1?

 

[general admission]

What would you tell me if I had a low-230s score?

What would you advise if I had a low 250s score?

 

[Frazier]

What would you tell me if I had a low-230s score?

What would you advise if I had a low 250s score?

Probably the same thing.

I think he was looking more to gauge, say, 210 vs. 250.

 

[Psai]

Don't play games when you're asking for help

 

[J ROD]

First, decide if you want to cut or not. That is usually an easy starting pt for many.

It also sounds like you are not really into Surgery but want to do it more bc it is expected and respected.

Internal Med might be right for especially with subs like Cards, GI

Also, Anes and EM should be on your list. IR as well.

Nobody can make the choice for you. But, I think the first thing I listed above is a good starting place.

 

[Ismet]

If you don't love surgery, don't do it. At least that's what I've been told. You feel "ok to good" about the OR, which doesn't seem like surgery would be for you. Or maybe you'd like something like ENT or ophtho which are a good mix of procedures and clinic.

 

[ACSurgeon]

I need some advice on this. The choice of which specialty has been nagging me throughout the whole year. I had some ideas in MS1-2, then went into third year SURE I was going to do a competitive surgical subspecialty. After rotating in it in third year, it didn't click with me. In fact, nothing has. I feel like I could be forced into anything and do fine and help people, but I'm not sure I'd be happy. I seem to change my mind once every few weeks, and get fixated on something. I've been set on like 8 different specialties throughout this year... Rads, every surgery specialty, multiple IM subspecialties, Gas, etc... If I had just stuck with something from the get go - anything - I feel like I would have been better off.

Part of me wonders if I'm just chasing prestige. I've thought about IM and then subspecialty, but then get second thoughts for reasons I feel like I shouldn't. I don't get that feeling of accomplishment that I have become something "cool" like a plastic surgeon, even though I don't think I'd like surgery as a career. How do I get over that? I suppose matching into a top IM namebrand would give me a similar feeling, but getting into one is a crapshoot.

I just can't figure this out. I feel like the opportunity of research for certain super-competitive specialties has sailed, leaving me less than comfortable with my chances. I have nagging feelings ("give surgery another shot, maybe you just had a bad experience") and feelings of telling myself to shoot for the stars while I still have a chance, not to "settle".

Where should I go from here? Should I pursue a surgical rotation in M4 to definitely see if I'd like surgery or not? I'm also not opposed taking a year off for research if it meant matching into something I eventually felt passionate about. I like clinic, I feel OK to good about the OR, I like procedures, I like challenge... I like teaching, I like research. Lifestyle is also growing in terms of "importance" to me. I'd appreciate any help.

Sounds like IM followed by a procedural fellowship. Most prestigious things require a lot of work. You don't sound like you're interested in doing a lot of work. You can't get both- easy life and prestige.

 

[VisionaryTics]

If you don't love surgery, don't do it. At least that's what I've been told. You feel "ok to good" about the OR, which doesn't seem like surgery would be for you. Or maybe you'd like something like ENT or ophtho which are a good mix of procedures and clinic.

ENT is not "surgery-lite". There seems to be a steady parade of medical students who rotate through ENT thinking it will be like gen surg with twice the prestige and a quarter the work.

Life as attending can be pretty good, but in the end it's a surgical field. It's just a surgical field in which more of your patients come from clinic, fewer from the ER, and there are more outpatient procedures.

Feeling "OK to good about the OR" is not a quality of any otolaryngologist.

 

[Ismet]

ENT is not "surgery-lite". There seems to be a steady parade of medical students who rotate through ENT thinking it will be like gen surg with twice the prestige and a quarter the work.

Life as attending can be pretty good, but in the end it's a surgical field. It's just a surgical field in which more of your patients come from clinic, fewer from the ER, and there are more outpatient procedures.

Feeling "OK to good about the OR" is not a quality of any otolaryngologist.

I stand corrected. Granted I have extremely limited experience, but when we rotated through ENT and ophtho, it was like 80% clinic 20% OR for the attendings I was with. But perhaps that was just location/attending-specific.

 

[WinslowPringle]

Agree, first question is do you want to cut. If the answer is "Well, ok," I'd recommend against GS or the integrated residencies, ortho, oto, nsrg, or uro. I think Optho and OB-Gyn would work fine with this answer, though.

What makes you go, "Oh, wow, that's cool?" On any rotations did you *want* to come in early and stay late? What about medicine in general do you like?

What about optho? (Or is that one of you 'every surgical subspecialty'?) Not 'surgery lite' exactly, but a different kind of surgical procedure. Good office opportunities, too. And it definitely offers options for research, challenge, and sub-sub-specialization.

Also, interventional rads? Rad onc?

 

[IMdoc2015]

Another way to think about it is to focus on the kind of patients you want to work with. Do you like getting to know your patients over time or managing chronic disease? Do you like the undifferentiated patient? How do you feel about treating children? Those kinds of questions really helped me make my decision when I started 4th year.

 

[IlDestriero]

When in doubt sell out for the $$$.

 

[tiedyeddog]

What would you tell me if I had a low-230s score?

What would you advise if I had a low 250s score?

Give us ballpark what you actually have, we are trying to help you. Do you have any research in what field?

Do you love actually being in surgery and doing it? Would you be ok being forced to lose sleep to do it?

 

[Donald Juan]

It sounds to me like you don't want to do surgery outside of your blind ambitions. Maybe you should make a list of things you like about fields, and decide what things you cannot live without, or what things about the jobs you would do for free just because they are fun to you. Obviously, a lot of things will overlap between fields, or be dependent on the capacity in which you decide to practice, but it could help you narrow some things down. I feel like if you've jumped on board with 8 specialties and then dropped them you must have figured out some of the things you like and dislike about them.

Also, I'm surprised you talk about prestige and only go toward surgical subspecialties. I don't know why a heme/onc or cardiologist doesn't seem prestigious to you. To me personally, IM feels like the peak of medicine. I revere a solid internist who can see and treat a variety of things and examine the entire body over an orthopedist who can replace a hip in 30 minutes but doesn't know how to treat a cold...and I say that as somebody who has declared a surgical subspecialty.

 

[Slack3r]

ENT is not "surgery-lite". There seems to be a steady parade of medical students who rotate through ENT thinking it will be like gen surg with twice the prestige and a quarter the work.

Life as attending can be pretty good, but in the end it's a surgical field. It's just a surgical field in which more of your patients come from clinic, fewer from the ER, and there are more outpatient procedures.

Feeling "OK to good about the OR" is not a quality of any otolaryngologist.

In academics maybe, but out in the community...

 

[tiedyeddog]

In academics maybe, but out in the community...

To be fair, most surgical specialties are practiced very differently outside of academics.

 

[Biochemist21]

There's that old crude saying, "If you love surgery and one other thing, do that other thing." I don't want to discourage people from surgery (it's a great field but not for me personally), but looking at my colleagues in the field, I think you have to have that deep burning desire to be a surgeon. Otherwise, when you roll over in bed to stare at your buzzing alarm clock, and it stares right back at you with the warm glowing digital display showing 3:31am, you're going to be miserable and your work is going to suffer as a result. Also try to look past the slog of residency and realize that those few years are only a small fraction of your future medical practicing career.

As mentioned above, keep asking amongst attendings and residents in the field why they chose the career they did. And if you're up for it, a research year could be really helpful. I think 2-3 of my med school classmates did it because they couldn't decide and it ended up working out wonderfully for them.

Finally, if by chance you pick ____ career and realize during residency that you think you've made a mistake, your life is not over. In my many conversations with residents and attendings during med school, I was very surprised how many made huge changes in their careers in order to find the specialty that gave them the most satisfaction. Rads to OB, surg to anesthesia, med to surg, and ENT to peds are among a few of the people who immediately come to mind. Some even made this switch after completing their first residency (for whatever reason both of those people switched into EM). The point is, don't let the bitterness of some people make you second-guess your ability to find the right specialty for you. IMHO, as long as you believe, deep down, that you truly love medicine as a career, eventually you will stumble upon the right thing for you.

 

[HumbleMD]

My biggest advise is not to choose something based on what everyone else thinks, i.e. prestige. What you'll quickly realize is that EVERY specialty talks crap about EVERYBODY else. That's why they're specialties. Gen Surgeons make fun of OBGYNs for being butchers, OBGYNs make fun of the EM doc for mismanaging a miscarriage, the EM doc makes fun of the IM doc for not knowing how to do an LP. The IM doc makes fun of the Surgeon for not knowing how to manage an abnormal Echo or a bad hypertensive. The circle of crap continues.

So when you put prestige and everything aside, dial down to what YOU really want to do. If you love rounding, think something more medical. If you hate it with a passion, then do something surgical. "If you love surgery and one other thing, do that other thing" is very true - the path is longer with worse hours, so only do it if you absolutely love it and can't imagine doing anything else. Otherwise you'll likely be dropping out February of your intern year.

 

[IveGotTwins]

Anesthesia resident about to graduate. I love my specialty and couldn't be happier. I was in a similar situation at your stage. Good luck in your search. As others have said your self awareness will serve you well for the rest of your career and life.

Short very true anecdote related to the surgery discussion:

This past weekend I was at work when the CV surgery attending looked up from the field, looked right into my eyes but I don't think he actually saw me. This man has been out of fellowship for 15 yrs. He said earlier in the day that he had not seen his family all week and and had not been home before 2am for the past four nights. At the time it was 7pm and he was trying to get a second room open for an add-on case. He said to himself or maybe to the universe, "Why did I do this? Why am I a surgeon?".

So later on that night we are finishing the add-on case since he never did get a second room and attending scrubs out to finally go home. The CV surgery fellow is closing the wounds when his pager goes off. The nurse answers for him and announces that a different CV surgery attending has a patient in the ER who had a recent femoral-popliteal bypass presenting with a cold ischemic leg. He stops what he is doing, sets the instruments down, bows his head and closes his eyes. He whispers to himself "why did I do this..... I can't....... thank you I'll see them when I am done here".

 

[qwerty89]

Anesthesia resident about to graduate. I love my specialty and couldn't be happier. I was in a similar situation at your stage. Good luck in your search. As others have said your self awareness will serve you well for the rest of your career and life.

Short very true anecdote related to the surgery discussion:

This past weekend I was at work when the CV surgeon looked up from the field, looked right into my eyes but I don't think he actually saw me. This man has been out of fellowship for 15 yrs. He said earlier in the day that he had not seen his family all week and and had not been home before 2am for the past four nights. At the time it was 7pm and he was trying to get a second room open for an add-on case. He said to himself or maybe to the universe, "Why did I do this? Why am I a surgeon?".

So later on that night we are finishing the add-on case since he never did get a second room and he scrubs out. The CV surgery fellow is closing the wounds when his pager goes off. The nurse answers for him and announces that a different CV surgery attending has a patient in the ER who had a recent femoral-popliteal bypass presenting with a cold ischemic leg. He stops what he is doing, sets the instruments down, bows his head and closes his eyes. He whispers to himself "why did I do this..... I can't....... thank you I'll see them when I am done here".

Wait it this story about 2 different people? An attending and a fellow?

 

[IveGotTwins]

Wait it this story about 2 different people? An attending and a fellow?

Yes. Fellow and attending working together in both cases and had the same epiphany.

I edited the original post to make it more clear.

 

[IlDestriero]

Yesterday I was done at 130, got a quick lunch at the cafe, hopped into my lux-o-wagon and blasted out into clear skies and 70 degrees. A glance down at my fine Swiss watch confirmed that it was not even 2. Taylor swift blasting, no that won't do, classic metal. Yes, Much better.
I need a convertible.
I got a text to sign out my last patient of the day and laughed out loud as I forwarded it to the call team as I didn't even recognize the patient's name anymore.

 

[IlDestriero]

Think about the above when you're doing your surgery internship for the prestige of it all.

 

[qwerty89]

Anesthesia resident about to graduate. I love my specialty and couldn't be happier. I was in a similar situation at your stage. Good luck in your search. As others have said your self awareness will serve you well for the rest of your career and life.

Short very true anecdote related to the surgery discussion:

This past weekend I was at work when the CV surgery attending looked up from the field, looked right into my eyes but I don't think he actually saw me. This man has been out of fellowship for 15 yrs. He said earlier in the day that he had not seen his family all week and and had not been home before 2am for the past four nights. At the time it was 7pm and he was trying to get a second room open for an add-on case. He said to himself or maybe to the universe, "Why did I do this? Why am I a surgeon?".

So later on that night we are finishing the add-on case since he never did get a second room and attending scrubs out to finally go home. The CV surgery fellow is closing the wounds when his pager goes off. The nurse answers for him and announces that a different CV surgery attending has a patient in the ER who had a recent femoral-popliteal bypass presenting with a cold ischemic leg. He stops what he is doing, sets the instruments down, bows his head and closes his eyes. He whispers to himself "why did I do this..... I can't....... thank you I'll see them when I am done here".

CT surg sounds awesome. So much prestige. Such wow.

BRB switching out of rads to go into CT surg.

 

[qwerty89]

Think about the above when you're doing your surgery internship for the prestige of it all.

On a side note I've run into a lot of people on the interview trail for rads that preferred surgery prelims to TYs because they thought they would learn more for IR. While they would say this all the residents would look at the applicant like they were bat**** insane.

 

[Gadofosveset]

On a side note I've run into a lot of people on the interview trail for rads that preferred surgery prelims to TYs because they thought they would learn more for IR. While they would say this all the residents would look at the applicant like they were bat**** insane.

That's cause it is.

The surgery pathway is going to be the new normal for the IR direct... but I've known fellow residents now in IR who did surgery prelims, and they would not do it again.

I know a few surgery residents who have left surgery residency and gone into rads residency to do IR. Only one thought his experience in surgery residency really helped him much in IR, and he was lukewarm about it.

 

[famoussquamous]

Well that depends OP, are you a nice or a mean person?

 

[FalconSlice]

Well that depends OP, are you a nice or a mean person?

Love every bit of this.

 

[Pedineurodoc]

First off, you need to forget about prestige. Yeah, it would be a good stroke to your ego to say "I'm a plastic surgeon" or some other competitive field that will make other people "ooh" and "ahh" about how smart you must be, but that feeling is not going to last long, especially when you're nose is to the grindstone and your soul is being sucked out because you are in a field that you don't love. Simply being a doctor should be enough prestige.

A great piece of advice that I got from an attending in my third year is "base your decision on how fun that rotation was for you." Even if you didn't get that "aha" moment from one of your rotations, if you had to go back and do one over again, which would you pick? That may be a good starting point for deciding what you want to do. If you would redo family medicine, but would rather have a field with more procedures, then look into EM. You'll still see a variety of patients back to back, and you'll also get to do lines and chest tubes, among other short procedures. If you would redo ortho, but don't want to spend several hours in the ER doing procedures, then consider PM&R. You need to tease out what aspects you did like about certain rotations, and then try to find the field that contains as many of those traits as you can find. Also, consider who you want to work with. Its much easier to spend your life doing a job that makes you go "eh" if you love the people that you work with. I honestly would have been much more inclined to surgery if it didn't require that I spend all my time with people who had surgeon personalities. Which group of residents did you mesh well with? While the personalities can vary greatly from hospital to hospital, you can pretty much always guarantee that surgeons are going to be a bit high strung, pediatricians are going to be very much in touch with their inner child, neurologists are going to be kinda geeky, etc. I'm doing Child Neurology, so I can definitely attest to the last two.

If you still can't decide, you might want to consider doing a prelim year (medical, surgical, etc) and let yourself experience some of the stuff as a physician rather than a student. It's quite different when you have all of the responsibility, rather than just being that random person in the short coat following the doctors around.