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[Interventional Ololology]

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Hello,

I’ve been chronically tormented by the ‘what field’ question since the start of med school and now its really coming down to the line. I’m an M4 and seriously do not know what to do.

In undergrad I majored in philosophy and studio art. I love all things mind and ‘working with my hands,’ so when I started med school I was thinking about either plastics or psych and figured the answer would become obvious. But it never did.

Pathophysiology is a fun game to play before any of it’s connected to actual suffering people and so during the preclinical years I got caught up in the crit care obsession and actually took a year off to do cardiology research, thinking I had evolved through my original intuition of what I might like. I also took a year long course at the local psychoanalytic institute coz freud is just good literature.

(btw, despite my nerdy interests, when people do the a priori specialty prediction game I’m typically classified as ortho/cards dudebro type.)

Anyhoot, come third year my first rotation was gen surg and I did not have a great experience, which I’m bitter about because I think it was mostly because it was my first and I suck at computers and struggled with the EMR/note writing process and felt awkward with the pressure to ‘be helpful’ when clearly brand new third years are 99% friction and my chief was just so unpleasant that every day was sooo unnecessarily stressful.

Ok so then my next rotations were brief stints in ortho and neurosurg which I actually did really like, for two weeks, but didn’t really see myself in. I was excited to do psych next, the one I thought I would love but… wrong! Inpatient psych is brutal! Its humiliating! Horrifying! Infuriating! Yes it can be fascinating and eye opening and overall it was ok but definitely did not make me fall in love like I had hoped.

I was… disappointed. Neither surg nor psych really worked out so I had to forge a new vision of my future. Rads stuck for a bit but soon crumbled. Neuro stole the show for a month but I couldn’t keep it up. Peds no. Obgyn no. Last rotation was medicine. Pulm/crit had me excited for about two months but by the time I was through on the general med floor my fascination with mechanisms just wasn’t doing the trick any more while the gnarly feet, the dyspnea and the suffer suffer suffering every damn day was making me anhedonic.

The 4th year AI/elective sign up frenzy was happening during my crit care phase so I signed up for all these medicine electives to get letters and what not and I’m on a med AI now, but against Ive started to think about psych. I think I’m a pretty strong applicant there, 250+ on step plus two research papers to my name (cancer and cards). But now I’m just like ****, am I really gonna do psych? Am I really gonna be sitting in a room with depressed/schizophrenic people for the rest of my life? Yeah sure neuroscience research is fascinating but I’m not cut out for hard core academics. I’m an extremely active and creative person and want so badly to help but also somewhat anhedonia prone and seriously fear that the psych ward and outpatient would mess me up. Maybe there are some people you can really help in psych. Maybe just ‘being with them’ and hearing out their story and not being a pill pusher could really be good. But then then I cycle back to plastics (which of course I have nothing set up for), and wonder if it was the solution to my question all along that I’ve ignored because of my beginning of 3rd year incompetence. I’m certain that if I’d done surgery at the end it would have been a completely different story, but hey that’s how it goes.

So there you have it. Its not that I cant construct a future, I can construct too many futures. I’m not one of those people whose fantasy about what a specialty is will override the actual experience and force fit into what I want it to be, and since there was no field that I felt was the clear winner I now have to do some ‘soul searching’ and make a non-trivial decision, aka, a decision.

I understand that questions like this are entirely personal and even though it torments me I do love the question and even wonder if my indecisiveness is just a sort of attachment to the question itself, but I feel like I’ve exhausted my strategies for collapsing the possibilities to one and so have set to write it all down and post it on the internet to see it anyone had any insight.

Thanks for reading.

 

[WedgeDawg]

Based on the length of your post, I think you should do internal medicine and then a heme/onc fellowship

 

[mrbreakfast]

The length suggests medicine, but the fact that this reads like a manic episode suggests psych, which backs up OP's assessment. But to try to dissect:

But then then I cycle back to plastics

You are not competitive for plastics at this time. Introspection is nice, but you need aways and papers and you're too late to the game for that.

wrong! Inpatient psych is brutal! Its humiliating! Horrifying! Infuriating!

Well, the only time you'd likely see it would be in residency. Something to consider. Anyone can do something for a few months.

I’m an extremely active and creative person and want so badly to help but also somewhat anhedonia prone and seriously fear that the psych ward and outpatient would mess me up.

Good news; the sardonic stereotype that psychiatrists could just as well treat themselves actually has some basis. You're a good fit!


Here's the unfortunate bottom line: as an M4 in July, you're in a pickle because you should have made this decision awhile ago. Anything requiring aways is out. You probably need to choose between medicine and psych.
-Medicine: you're basically set up for this, which is a plus. You don't have to do cards, and if you like treating people with psych issues, they can certainly be found in different medicine subspecialties.
-Psych: what you seem to like best, though you need to think seriously if this is what you want to do, as if it is, you need to change your schedule ASAP.

Basically, try to imagine yourself in 10 years. Think what kind of work life you would like. Think of what specialties will give you that. Then, of those specialties, decide on which clerkship you spent the least amount of time looking at the clock. There's your choice right there.

There's also a third option, which is just doing both, as a med/psych residency. I don't know a ton about it, but because physical and mental illness may often accompany one another, it's likely a good choice for people interested in managing both. Someone in my med school class matched into it.

My recommendation would be to try to change your August rotation to a psych rotation that would help you decide. Something like an outpatient AI, if your program has those.

 

[Dantes]

Based on the length of your post, I think you should do internal medicine and then a heme/onc fellowship

Very helpful lol

OP if inpatient psych isn't your thing you would only have to do that during residency. Still plenty of need for outpatient psych almost everywhere.

 

[OrthoTraumaMD]

The length suggests medicine, but the fact that this reads like a manic episode suggests psych

This is brilliant.
That’s it, I have nothing else to say nor any advice to offer.

 

[Chelsea FC]

PM&R?

 

[Tenk]

This is psych. Internal medicine would have had more bullet points/lists.

 

[sloop]

PGY-3 psych resident here.

It might be helpful if you told us what about psychiatry was so off-putting to you. I might be able to weigh in on whether those concerns are valid reasons to write the field off as a career option.

One thing I will say is that there are aspects of your post that are concerning for fundamental misconceptions about what psychiatry is and attitudes that are inconsistent with being a good psychiatrist.

Specifically, you seemed to imply that "being with them", hearing them out and not being a "pill pusher" might be the formula for being a good psychiatrist. This is incorrect as psychiatry is much more than just being a supportive person. As a psychiatrist, you are an expert in diagnosis of psychiatric disorders and initiation of treatment. Regarding treatment, your post is full of phrases that imply that you might be anti-medication in psychiatry, such as "pill pusher" and " [ . . . ] brutal! Its humiliating! Horrifying! Infuriating!" If you are against medication in psychiatry, that should be a contraindication to becoming a psychiatrist. Like it or not, medications are essential to the treatment of many psychiatric disorders. Similarly, you should probably not go into psychiatry if you have serious and rigid opinions about paternalism as caring for some of our sickest patients is going to involve things like involuntary commitment and medication over objection.

Regarding the negative emotions related to being around mental suffering: it gets easier. Most people are able to find ways of doing this job without having profound and lasting effects on their mood. This is not necessarily a reason to avoid psychiatry.

 

[Giovanotto]

Why didn't you like about neuro?

 

[nimbus]

If you didn’t like anything, try anesthesia. That’s what I did and it worked out great. And unlike psych meds, propofol works every single time.

Seriously, if you were my kid, you would suggest internal medicine which allows you to delay the branching off point a few more years. You can go all outpatient clinic stuff, very cerebral or not, or you can be very procedural like structural interventional cardiology which IMO is one of the most exciting areas of medicine at the moment.