Help picking a specialty- M3 USMD

[millerthelab1001]

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I’m a current third-year USMD student working to choose a specialty. I enjoy all the different organ systems equally and want to focus deeply on a single area. I love using my hands, and my time on the surgery rotation has been particularly rewarding because I can enter a flow state in the OR—it feels like playing a video game, where I'm so focused that I lose track of time.

However, my top priority is my life outside of medicine. At the end of the day, this is a job to me, and I have an amazing wife who isn’t in medicine, along with our dogs, and I want to ensure I have time to spend with them. Outside of work, I love going to the gym, playing video games, and watching football with my wife and dogs. Ideally, I’d like a specialty that allows me to engage deeply and use my hands—like being in a game—but also gives me the balance to enjoy life beyond the hospital. I’m in the upper half of my class and have a few research experiences under my belt.

 

[operaman]

Sounds like one of the surgical subs is what you’re looking for. ENT, Ophtho, Uro- all of those offer what you’re seeking. Alternately, something like derm with a mohs fellowship would do it too. Anesthesia would also check most/all of your boxes.

Drawback is that these are all pretty competitive fields so you would need to make some big decisive moves quickly if you want to make a strong application in 9-10 months.

 

[Lost in Translation]

Ophtho makes the most sense to me based on your criteria. You would be the expert in your single organ system, there are microsurgical procedures that are demanding and challenging, 8-4 clinic, and basically no call as there are very few true ophtho emergencies.

 

[VincentAdultman]

Just do orthopedics. You know what’s really in your heart…

 

[LucidSplash]

Something procedural like GI with ERCPs and scopes could also be your jam.

 

[MrBigglesworth]

Dermatology followed by Mohs is the best of both worlds in my biased opinion

 

[Cognovi]

You should note that prioritizing life outside of medicine is not well aligned with the routes to a procedural subspecialty unless those procedures are purely outpatient and the primary specialty that leads into it does not have much emergency or inpatient management. Pretty much just Mohs. If you're willing to sacrifice some years of youth, then it would be an option to do a surgical specialty program (long hours) that then leads to a subspecialty that has a more predictable workstyle (eg, ENT; ophtho; urology; plastic surgery; obgyn).

If you can expand your mind beyond the using-hands part, then I would suggest radiology, in which you can focus and have a video game-like experience. Literally you're at the computer solving a puzzle that requires deep engagement. The work is shift based, so schedules are predictable and conducive to life outside medicine. The average hours worked in radiology residency is about 50-55, unlike the 60-70 in procedural specialties. The training in radiology does require knowing about all different organ systems, unlike dermatology, and then you specialize into one organ area for fellowship, but practice can be either general or subspecialized, so you have time to decide.

 

[millerthelab1001]

After some careful thought, I’ve narrowed down my specialty interests to anesthesiology and radiology. I’d love to hear any insights on what type of person might enjoy each field. I know that experiencing rotations will be key to making my final decision, but I’d appreciate any outside perspectives in the meantime. Thanks so much for all your help and advice!

 

[LunaOri]

Have you considered forensic pathology? It’s pretty exciting, and pathology residency is relatively benign.

 

[voxveritatisetlucis]

After some careful thought, I’ve narrowed down my specialty interests to anesthesiology and radiology. I’d love to hear any insights on what type of person might enjoy each field. I know that experiencing rotations will be key to making my final decision, but I’d appreciate any outside perspectives in the meantime. Thanks so much for all your help and advice!

I would do anesthesia. Less vulnerable to AI. And before I get downvoted, put any CXR or CT into 4o and it will match the impression on the report most of the time. Now imagine how advanced it will be in 6 years when you can practice as an attending

 

[Kierkegaard's Bud]

I would do anesthesia. Less vulnerable to AI. And before I get downvoted, put any CXR or CT into 4o and it will match the impression on the report most of the time. Now imagine how advanced it will be in 6 years when you can practice as an attending

Let's close down radiology residency, right?

 

[Cognovi]

I would do anesthesia. Less vulnerable to AI. And before I get downvoted, put any CXR or CT into 4o and it will match the impression on the report most of the time. Now imagine how advanced it will be in 6 years when you can practice as an attending

I just put in one CXR from Radiopaedia, which is on the open internet and GPT could have been trained on, and it missed the diagnosis entirely.

GPT-4 is not ready for medical image analysis. https://pubs.rsna.org/doi/10.1148/radiol.242286

 

[Cognovi]

After some careful thought, I’ve narrowed down my specialty interests to anesthesiology and radiology. I’d love to hear any insights on what type of person might enjoy each field. I know that experiencing rotations will be key to making my final decision, but I’d appreciate any outside perspectives in the meantime. Thanks so much for all your help and advice!

I wrote this with the help of GPT.

Anesthesiology​

• Strong Command of Physiology: Anesthesiology requires a deep understanding of physiology and pharmacology. In managing anesthesia, you’re constantly adjusting for changes in blood pressure, heart rate, oxygenation, and more, which relies heavily on a thorough grasp of real-time physiological responses.
• Focused Medical Knowledge: While anesthesiologists do encounter patients with a range of underlying conditions, their primary role centers on optimizing the patient’s status for surgery and safely managing them perioperatively. This translates to an in-depth focus on cardiopulmonary physiology and pharmacologic interventions rather than a broad exploration of pathology.
• Acute, High Cognitive Load: The cognitive workload in anesthesiology is intense but often comes in shorter bursts, requiring rapid problem-solving and decision-making during procedures or in response to acute changes in patient status.
• Thrives in High-Stakes, Real-Time Decision Making: Anesthesiologists frequently make critical, split-second decisions during surgery or in acute care settings. If you enjoy being in situations where you have to think on your feet and act quickly, this might be appealing.
• Enjoys Hands-On, Procedural Work: Anesthesiology involves a variety of procedures, from intubation to regional blocks, which can be fulfilling if you like technical skills and procedures.
• Appreciates Direct Patient Interaction: Though you may only meet patients briefly before surgery, the patient interactions you do have are often essential to helping them feel at ease and informed.
• Team-Oriented: You’ll work closely with surgeons, nurses, and other perioperative staff, which could suit someone who enjoys a collaborative work environment.
• Supervisory Role with Mid-Levels: Anesthesiologists often supervise CRNAs and anesthesiologist assistants, which can add a layer of responsibility to their role. This includes overseeing anesthesia plans, intervening in complex cases, and being available for consultation or emergencies. For some, this leadership role is fulfilling, as it allows them to mentor others and provide high-quality oversight.
• Increasing Scope of Practice for Mid-Levels: In some settings, mid-level providers are given a high degree of autonomy, which has led to debates about the quality and consistency of care when anesthesiologists are not as involved in direct patient management. This trend has led to what some anesthesiologists feel is “encroachment,” as the lines between physician-led and mid-level-led anesthesia care become blurred in certain healthcare systems.
• Balancing Clinical and Supervisory Duties: The supervision model can vary from a hands-on collaborative approach to a more supervisory or even managerial role, depending on the setting. This dynamic may influence job satisfaction, as some anesthesiologists prefer direct patient care over administrative or supervisory tasks, while others find value in leading and supporting a team of providers.

Radiology​

• Extensive Knowledge of Anatomy and Pathology: Radiologists need a comprehensive understanding of anatomy and pathology, as they interpret images across nearly every body system. Each case presents new challenges, requiring recognition of diverse disease processes and subtle anatomical variations.
• Broad, Systematic Medical Knowledge: Radiology covers a broad spectrum of diseases, from neurological to musculoskeletal to gastrointestinal conditions. This field requires a wide medical knowledge base and the ability to integrate clinical findings with imaging to inform diagnoses across specialties.
• Sustained, High Cognitive Workload: Radiology involves sustained cognitive effort, particularly when interpreting complex cases or managing a heavy caseload. The work is highly analytical, often requiring a methodical approach and attention to subtle details to ensure diagnostic accuracy.
• Detail-Oriented and Analytical: Radiologists spend much of their time interpreting images, and the ability to notice small details and integrate clinical information is crucial. If you enjoy the intellectual puzzle aspect, radiology could be a good fit.
• Prefers a Structured, Controlled Environment: Unlike anesthesiology, radiology often offers a more predictable environment, typically in an imaging suite rather than an operating room or ICU.
• Enjoys Working Independently: Radiology can appeal to those who are comfortable working autonomously, especially in settings where you may spend a lot of time reading and interpreting studies without direct patient interaction.
• Technology Enthusiast: Radiology is at the forefront of technological advances in medicine. If you’re interested in digital imaging, AI, and the evolving tech side of medicine, radiology has a lot to offer.
• “Doctor’s Doctor”: Radiologists are often referred to as the “doctor’s doctor” because they act as consultants for other physicians. They collaborate with a wide range of specialists—oncologists, surgeons, internists, and more—to help clarify diagnoses and guide patient management.
• Bridge Between Generalists and Specialists: Radiologists serve as a bridge, synthesizing information from primary care physicians and specialists alike to provide a holistic view through imaging. They’re integral to guiding the next steps in patient care, often influencing treatment plans based on their diagnostic input.
• Indirect Patient Impact: While direct patient contact is limited, radiologists impact patient care significantly through their expertise and the insights they provide to the healthcare team. Communication skills are essential in conveying findings accurately and concisely to other physicians, often through reports and multidisciplinary discussions.
• Remote Work Opportunities: Radiology is one of the few medical fields where remote work is increasingly viable. With advances in teleradiology, many radiologists can interpret imaging studies from home or other locations outside the hospital. This flexibility can offer better work-life balance and is especially appealing to those who value autonomy in their work environment.
• Variety of Practice Settings: Radiologists have the option to work in a wide range of settings, from academic hospitals and outpatient imaging centers to private practices and telemedicine companies. Each environment provides different lifestyle and workflow options, allowing radiologists to tailor their careers to their preferences.
• Customizable Work Hours: While radiology still has its share of demanding shifts, particularly in hospital settings, some radiologists are able to customize their hours based on their practice model. Part-time, per-diem, or even nighttime reading options are available in certain areas, adding another layer of flexibility for those who prefer non-traditional schedules.

 

[AJS59]

I would do anesthesia. Less vulnerable to AI. And before I get downvoted, put any CXR or CT into 4o and it will match the impression on the report most of the time. Now imagine how advanced it will be in 6 years when you can practice as an attending

Again, even if AI gets advanced the law will never let this happen. You can't sue an AI

 

[mistafab]

Anesthesia is much less solitary in your day-to-day work than radiology.

Radiology requires much more lifelong learning.

Radiology is closer to pathology.

Hope this helps.

 

[Cognovi]

Again, even if AI gets advanced the law will never let this happen. You can't sue an AI

You could sue the company that makes the AI. Which is why companies will not do that.

 

[voxveritatisetlucis]

I just put in one CXR from Radiopaedia, which is on the open internet and GPT could have been trained on, and it missed the diagnosis entirely.
View attachment 395212

GPT-4 is not ready for medical image analysis. https://pubs.rsna.org/doi/10.1148/radiol.242286

Which radiopedia article? Did you use O1 or 4O?. O1 can reason.

Either way, even if AI doesn’t replace radiologists and just increases productivity then the job market will crater and new grads may get 110k offers (post residency) to serve as AI supervisors because if you’re a practice owner/partner and can do all the scans yourself, why hire somebody?

 

[Cognovi]

Which radiopedia article? Did you use O1 or 4O?. O1 can reason.

Either way, even if AI doesn’t replace radiologists and just increases productivity then the job market will crater and new grads may get 110k offers (post residency) to serve as AI supervisors because if you’re a practice owner/partner and can do all the scans yourself, why hire somebody?

Case of scimitar syndrome. https://radiopaedia.org/cases/scimitar-syndrome-27 Using free chatgpt so 4o.

There's not enough productivity increase possible to crater the job market. As long as I still have to look at all images and synthesize it with the chart and correct the report. In radiology we have neared maxed out on productivity. Maybe 20% more is possible. And in this job market we are 20% understaffed so any help is appreciated..

I have the human version of AI. They're called fellows. These are board eligible radiologists who have finished residency and write whole radiology reports for me. They could be general radiologists out in the community and perform at a similar level. They also do all the grunt work of protocolling and messaging clinicians with urgent findings. Yet I still have to do the work of checking their work by reviewing all the images, reading their report, and correcting their report. In this setting, my productivity is similar to that of private practice radiologists who are reading by themselves. It's not higher.

You are pulling numbers out of your ass. 110k GTFO.