Trying to decide between OB, EM, IM, GS. Pls help
Help with specialty
- Thread starter KMANE
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you are all over the place with your interests which is okay. you need to ask yourself two questions. do you live for the OR? do surgery or OB. are you able to manage going through an IM residency and possibly becoming a hospitalist? do IM. you are a us md and will have no problem getting into cards. i would say your interests and desire to pursue fellowship may change which is why i ask if you are comfortable becoming a hospital doc. EM is going to be tough with you given the step 1 score, no offense. i think OB is a trickier match too but more likely than EM. good luck and let us know if you have any other questions.
edit: i would also ask yourself about lifestyle. do you have a family? what is the plan during residency? GS and OB are grueling and i could not imagine having children during that time.
edit: i would also ask yourself about lifestyle. do you have a family? what is the plan during residency? GS and OB are grueling and i could not imagine having children during that time.
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Dont do OB. Its like being a dentist. No one is happy to see you. No one likes their annual exam, no one is happy to wait for their epidural because you are not in the hospital. Lifestyle is bad, lots of lawsuits. Most of OB is happy times. When it's not, it's really bad. Fetal demise, etc..
Good point. Everyone is always thrilled to see the EM, IM or GS docs, and they NEVER get sued
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Do you know what an annual OB/GYN exam consists of? Primary care docs do some OB/GYN, and those visits are not that common. Not several times a day as they are for OB/GYNs.
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“Most” OB patients are healthy. Gyn, sure older population, unless gyn onc, still pretty healthy. On top of that if they come to see you for their annual exams, in general they’re “good” and compliant patients.
IM, not sure if you can make those generalization. I’ve never worked in a private practice outpatient IM in a good neighborhood, so my optic maybe not be accurate.
EM and GS can certainly be more stressful, because of the acuity of the problems.
Observe your attendings. Are they what you want to be when you grow up? There’s certain “personality” for each speciality.... stereotype usual exist for a reason.
Good luck.
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I would not decide on not doing OBs based on not liking annual exams. It’s a very versatile field you could do office only (though would recommend FM if that’s your schtick), laborist (hourly job but pays well), or subspecialiaze. The caveat is if you stay a general obgyn your practice will consist primarily of obstetrics, office and minor surgeries unless you’re in the boonies majority of majors medium and large metros are done by onc, urogyn and MIGS. GS is sort of similar in terms of subspecialiazation; but you’ll still be doing way more surgery and way less clinic than a general obgyn. So if you’re more into surgery and can live without OB I’d say GS, only because OBGyn surgery fellowships are very competitive and I’ve seen a lot of people be severely disappointed when they don’t match and are left with the only option of practicing as a generalist.
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Pick the specialty you can live with despite the negatives :
OB= Vaginas, vaginas, vaginas. Pregnant Women. Delivering babies (forget your plans for the evening). Can do surgery, but (unfortunately) not generally viewed as equals amongst other surgical specialties.
EM= Primary care for the uninsured, jack of all trades master of none (potential to mismanage more complex problems), oh yeah and the unexpected arrival of dying people and a homeless person jacked up on ketamine ready to "wr-AH-stle"
IM= Rounding, rounding, rounding, notes, notes, notes. Arguably the specialty that gets dumped on the most (prove me wrong). Managing diseases you can't fix (either a chronic disease, or patients that refuse to take care of themselves-think diabetic admitted with a 84oz Big Gulp of Mountain Dew Code Red)
GS= Frequently...ahem... FREQUENTLY consulted (which is always conveniently happens when you are in the OR wrist deep in poop or in bed at home). Arguably the surgical speciality that gets dumped on the most. Despite loving the OR, has to have clinic to funnel patients into the practice.
.... I'd pick my same path every day.
OB= Vaginas, vaginas, vaginas. Pregnant Women. Delivering babies (forget your plans for the evening). Can do surgery, but (unfortunately) not generally viewed as equals amongst other surgical specialties.
EM= Primary care for the uninsured, jack of all trades master of none (potential to mismanage more complex problems), oh yeah and the unexpected arrival of dying people and a homeless person jacked up on ketamine ready to "wr-AH-stle"
IM= Rounding, rounding, rounding, notes, notes, notes. Arguably the specialty that gets dumped on the most (prove me wrong). Managing diseases you can't fix (either a chronic disease, or patients that refuse to take care of themselves-think diabetic admitted with a 84oz Big Gulp of Mountain Dew Code Red)
GS= Frequently...ahem... FREQUENTLY consulted (which is always conveniently happens when you are in the OR wrist deep in poop or in bed at home). Arguably the surgical speciality that gets dumped on the most. Despite loving the OR, has to have clinic to funnel patients into the practice.
.... I'd pick my same path every day.
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this is correct for general obgyn but not for urogyn or oncology who incidentally also do not necessarily view generalists as “surgeons”. Incidentally urogyn rarely gets dumps vast majority of patients are health/greatful/not entitled, lots of things left to be discovered (good chance to make a big impact in the field if you stay in academics),
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Obsterstrics = If you like endless on-call for births and deliveries; plus managing needy mothers and their precious pregnancies
Internal Med = If you like endless clinic duty and ward rounds, sometimes dealing with complicated multi-co-morbid patients that never get better, and doing consults for general adult medicine for the entire hospital and emergency department
Emergency = If you like the endless chaos of working a 10+ hour shift seeing a complete spectrum of cases from serious trauma to a benign cold, but don't have to deal with ward rounds or outpatient clinic follow-up; just do your shift and go home
Surgery = If you have the stamina to do morning round, clinic duty, operations throughout the day, consults throughout the day, and evening rounds; and, you're good with your hands at doing procedures and don't mind standing and walking most of your day
Humor aside, I would suggest you choose something that you can see yourself doing for the rest of your life. Every specialty has its downsides and upsides. I dual trained in Emergency and Family Medicine. Emergency is a young man's game if you like that type of stuff but gets old and tiring. Most seniors in EM end-up trying to look at minimising their time on the frontline because of this, and end up with part-time jobs in academia or administration instead. I ended up transitioning and falling in love with Family Med because I got to see patients (along with their families) on a more consistent basis, and it's a lot better on lifestyle and kinder on my family; and if I wanted to do the hospital stuff I still could as well.
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EM sounds great but on practical terms I’m worried about how the future looks. There are 2,400 new EM docs coming out of residency every year and less than 1,000 are retiring. I have to wonder where these new jobs are going to come from? In the past two years, the EM market in the large Texas cities that were previously wide open has gotten a lot tighter.
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if u dont know what u want, IM is a good choice because there are alot of options. you can do hospital work, clinic work, various subspecialties.
unless surgery is ur big calling, then u'll likely find something u enjoy under the various options of IM.
i do second the above on OB - with many specialties u are seeing alot of really old/demented/sick people without any real chance of getting better, and ur sorta just helping them hang on. the one big positive i see in OB is that its a speicalty where u see all young people that DO get better and go on to live normal lives because u did ur job right.
unless surgery is ur big calling, then u'll likely find something u enjoy under the various options of IM.
i do second the above on OB - with many specialties u are seeing alot of really old/demented/sick people without any real chance of getting better, and ur sorta just helping them hang on. the one big positive i see in OB is that its a speicalty where u see all young people that DO get better and go on to live normal lives because u did ur job right.
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That and working weird overnight 24 hour shifts and changing hours/sleep cycles sounds miserable when you’re 55...
I think people severely underestimate just how hard it is to change sleep cycles repeatedly if you’ve never done it before and trying to balance the rest of life (kids, etc)
This is to say nothing about getting attacked by homeless people on PCP, doing 5 suicide evals per night and seeing the same 15 patients every week for the the duration of time you practice at a given facility.
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Upsides of EM:
- Deal with acute issues; no chronic follow-up
- Actually save lives of people who are critically unwell
- Do your 10+hour shift and you're done; no work to take home
- Wide variety of useful clinical skillsets; the 'acute generalist' jack of all trades
- Can work in pre-hospital retrieval (helicopters or fixed wing aircraft or ambulances) if you like that kind of stuff
Downsides of EM:
- Shift work is tiring especially as you get older
- Having to routinely deal with the full spectrum of idiots, drunks, druggies, mental crises, etc.
- Having to deal with very sick people sometimes that die; especially paediatric trauma is most unnerving
- You generally can only work in hospital Emergency Deparments, which within itself is hard to find a staff position since there are so many EM docs now
- Deal with acute issues; no chronic follow-up
- Actually save lives of people who are critically unwell
- Do your 10+hour shift and you're done; no work to take home
- Wide variety of useful clinical skillsets; the 'acute generalist' jack of all trades
- Can work in pre-hospital retrieval (helicopters or fixed wing aircraft or ambulances) if you like that kind of stuff
Downsides of EM:
- Shift work is tiring especially as you get older
- Having to routinely deal with the full spectrum of idiots, drunks, druggies, mental crises, etc.
- Having to deal with very sick people sometimes that die; especially paediatric trauma is most unnerving
- You generally can only work in hospital Emergency Deparments, which within itself is hard to find a staff position since there are so many EM docs now
