How do medical students pick a specialty?

[Lokhtar]

I'll be starting med school soon and thankfully I don't have to decide for four years what I want to do, but I'm wondering what the usual process is? I mean right now, I don't think I have any clue and I'm guessing most people don't have an idea until their third or fourth year? Obviously you could want dermatology as a pre-med but if you get a 194 on your Step I, it's going to be difficult...or you could do a rotation and hate the specialty.

But there are many specialties that you don't rotate through your third or fourth years...so you may not think you're interested but if you had only tried it, maybe that was the one you would have fell in love with. So I'm wondering how you guys (3rd and 4th years, residents, etc) decided? Process of elimination? Did you guys shadow during your first and second years? Anyone have a 'Aha!' moment, maybe too late?

---

Members don't see this ad.

 

[drizzt3117]

Besides learning the basics of medicine, the most important thing you'll do in med school is decide what field to go into. IMO that's also the hardest task.

As someone who was dead set on a field going in and had thought it through with very valid reasons, I still found committing to a field very tough. I'll be applying in rads, but I really like surgery a lot. Honestly, if there's fields you're interested in, try to shadow or do electives, you may like them more or less than you think. 3rd year is when you're really going to figure things out, though.

In terms of overall strategy, I'd try to decide 1) if you want to do procedures 2) if you want continuity of care 3) If you like working in a Hosp or clinic more 4) if you like rounds 5) what lifestyle are you comfortable with.

In the end, I'm going to do prelim Surg then rads, which I think will be nice.

I'll be starting med school soon and thankfully I don't have to decide for four years what I want to do, but I'm wondering what the usual process is? I mean right now, I don't think I have any clue and I'm guessing most people don't have an idea until their third or fourth year? Obviously you could want dermatology as a pre-med but if you get a 194 on your Step I, it's going to be difficult...or you could do a rotation and hate the specialty.

But there are many specialties that you don't rotate through your third or fourth years...so you may not think you're interested but if you had only tried it, maybe that was the one you would have fell in love with. So I'm wondering how you guys (3rd and 4th years, residents, etc) decided? Process of elimination? Did you guys shadow during your first and second years? Anyone have a 'Aha!' moment, maybe too late?

 

[Dwindlin]

In terms of overall strategy, I'd try to decide 1) if you want to do procedures 2) if you want continuity of care 3) If you like working in a Hosp or clinic more 4) if you like rounds 5) what lifestyle are you comfortable with.

I am still a second year but I hear this type of approach used a lot and it seems to work well for people. Some of the advice I've been given is to break it down into smaller decisions, i.e. do I like surgical/non-surgical, adults, kids, or both, etc, etc.

 

[xanthomondo]

Well, what made you want to go into medical school in the first place?

In the first 2 years you'll kind of gravitate towards liking some subjects better than others (ie I loved cardio, but hated GI), as such I really, really enjoyed being on a cardio service. You might be able to use that to narrow down a small list of specialties, and then try to get some experience in each potential winner to see if you like the clinical part of the field.

Also what drizzt mentioned above is important as well.

 

[Law2Doc]

I'll be starting med school soon and thankfully I don't have to decide for four years what I want to do, but I'm wondering what the usual process is? I mean right now, I don't think I have any clue and I'm guessing most people don't have an idea until their third or fourth year? Obviously you could want dermatology as a pre-med but if you get a 194 on your Step I, it's going to be difficult...or you could do a rotation and hate the specialty.

But there are many specialties that you don't rotate through your third or fourth years...so you may not think you're interested but if you had only tried it, maybe that was the one you would have fell in love with. So I'm wondering how you guys (3rd and 4th years, residents, etc) decided? Process of elimination? Did you guys shadow during your first and second years? Anyone have a 'Aha!' moment, maybe too late?

Med school is poorly structured in terms of deciding on a specialty IMHO. If you don't fall in love with one of the core rotations during 3rd year, in most cases you have about 2 electives to play with in 4th year before it's time to get ERAS underway and have your letters lined up. (even less time than that for early match things)

I agree with folks who suggest making broad brush cuts to narrow your interests. Do you want something surgical or nonsurgical is the biggest cut, and in fact is pretty natural since personalities and identities are pretty different on either side of the fence. At most hospitals (and even on Scrubs) they even wear different colors to emphasize the distinction. If you choose surgery, you may decide if you want to subspecialize into a certain body part (ENT, Uro, Optho, Ortho, neurosurg, plastics), although there are many subspecialties where you can start out in general surgery and do a fellowship to subspecialize (vascular, cardiothoracic, minimally invasive, etc). If you choose a nonsurgical direction, the question becomes do you want to work with adults and kids, just adults, or just kids. From there it's a question do you like doing procedures? And so on. So you can narrow things down nicely.

But there will be fields you won't get a rotation in until early 4th year as an elective. So if you have a few fields that you are curious about, finding a few hours a week during the latter half of first year and any of second year is not a bad idea. There is simply no other way you are going to get much exposure before it's time to apply in things like rad onc, anesthesia, optho, radiology, derm, PM&R etc if you don't find your way into your own shadowing positions. In most cases the specialists would have no problem with med students coming by to shadow them, and it's not a bad way to network for the future. It's surprising more people don't do this. Every year there is someone who does an elective or two in early 4th year on something they thought they were going to like but didn't, and as a result, they back into something more general like IM which may or may not have been the right choice for them. A bit of shadowing early on could have helped this. Then again, there's always some people who fall in love with a core rotation and are basically "done" with their search by early 3rd year.

 

[J ROD]

Besides learning the basics of medicine, the most important thing you'll do in med school is decide what field to go into. IMO that's also the hardest task.

As someone who was dead set on a field going in and had thought it through with very valid reasons, I still found committing to a field very tough. I'll be applying in rads, but I really like surgery a lot. Honestly, if there's fields you're interested in, try to shadow or do electives, you may like them more or less than you think. 3rd year is when you're really going to figure things out, though.

In terms of overall strategy, I'd try to decide 1) if you want to do procedures 2) if you want continuity of care 3) If you like working in a Hosp or clinic more 4) if you like rounds 5) what lifestyle are you comfortable with.

In the end, I'm going to do prelim Surg then rads, which I think will be nice.

1. yes
2. no
3. hospital
4. NO!!!
5. I dont care when I work....just dont want to work more than 50hrs.wk once I am an attending.

What am I?

 

[J ROD]

http://www.smbs.buffalo.edu/RESIDENT/CareerCounseling/interior.htm?self-assessment.htm

 

[shadowfox87]

We write down a lot of specialties on small sheets of paper, roll them up and toss it in a box. Then pick one roll randomly.

 

[alwaysaangel]

1. yes
2. no
3. hospital
4. NO!!!
5. I dont care when I work....just dont want to work more than 50hrs.wk once I am an attending.

What am I?

EM or ENT

 

[alwaysaangel]

Its very different depending on the person.

Some people come in with an idea...get involved in the specialty in 1st and 2nd year and then confirm it when they do their rotation 3rd/4th year (this was me for EM)

Some people either do or don't have an idea of what they want but get to a rotation during third year and fall in love.

Some people use 3rd year as a rule out period to figure out what they DON'T want to do.

Some use logical lists of the lifestyle, etc to decide what would work for their personal life then pick what they like best.

Its really dependent on the person but for a lot of people they don't know until 3rd/4th year. So don't be in a rush, you will know when you know.

 

[J ROD]

EM or ENT

nonsurgical.....likes broad knowledge, both adults and kids, more adults though...

 

[alwaysaangel]

nonsurgical.....likes broad knowledge, both adults and kids, more adults though...

Ok, so EM.

 

[J ROD]

Ok, so EM.

that is what I get every time I take a survey......

 

[Lokhtar]

This all makes sense. My questions...when should a med student start shadowing, and is it easy to get shadowing opportunities as a med student? As a pre-med, it's a pain in the butt to keep calling and calling, waiting for people to let you shadow them.

 

[drizzt3117]

This all makes sense. My questions...when should a med student start shadowing, and is it easy to get shadowing opportunities as a med student? As a pre-med, it's a pain in the butt to keep calling and calling, waiting for people to let you shadow them.

Immediately, yes.

 

[J ROD]

This all makes sense. My questions...when should a med student start shadowing, and is it easy to get shadowing opportunities as a med student? As a pre-med, it's a pain in the butt to keep calling and calling, waiting for people to let you shadow them.

I shadowed EM, FM, Anes, Plastics, ENT, Derm, GI, Optho, Hospitalist, Peds, Geriatrics, Psy, etc...

before med school.

I just kept at it and got connections along the way.

 

[bronx43]

Money and prestige (which is really an extension of money).

Next question...

 

[Lokhtar]

I shadowed EM, FM, Anes, Plastics, ENT, Derm, GI, Optho, Hospitalist, Peds, Geriatrics, Psy, etc...

before med school.

I just kept at it and got connections along the way.

Ugh, maybe I just had bad luck then - maybe 1/10 or less returned my call/emails. Same process in med school? That's a little bit annoying.

 

[alwaysaangel]

Ugh, maybe I just had bad luck then - maybe 1/10 or less returned my call/emails. Same process in med school? That's a little bit annoying.

Nah. In med school you have a white coat and ID badge and therefore hospital privileges. You can just show up and ask to follow anyone.

 

[BPlaysItCool]

Nah. In med school you have a white coat and ID badge and therefore hospital privileges. You can just show up and ask to follow anyone.

Exactly. Physicians who are attached to a teaching hospital at your medical school tend to be very amenable to teaching. They generally see it as part of their role to explain their work wihin reason. If you make a shadow date and stay out of their way and just try to learn and try to be minimally useful like fetching charts or whatever. And you show a genuine interest in what they do. You will come away with something perhaps many things learned. If you're lucky you might just link up with a person you really respect and enjoy their company. And then you can measure your future self in their shoes. To imagine yourself in that career decades in. Do you feel intuitively that you would still be interested in the work. If you find this you're done.

One thing I disagree with the general consensus on is that you have until 3rd year to do all this. False. You're picking a dance partner for life! Only an idiot would allow that to the chance interplay of the 3rd year speed dating scene. Where your date is grading you.

 

[J ROD]

Ugh, maybe I just had bad luck then - maybe 1/10 or less returned my call/emails. Same process in med school? That's a little bit annoying.

I live in the South where folks may be more friendly and I called my med school and asked them for docs I could shadow and they told me others that I could shadow,etc.

Basically, I networked it so I did not have to do it cold where I had no "in" with the doc.

 

[Law2Doc]

Exactly. Physicians who are attached to a teaching hospital at your medical school tend to be very amenable to teaching. They generally see it as part of their role to explain their work wihin reason. ....

Yeah, I wouldn't do it as a formal shadowing appointment. Just put on nice clothes, your white coat, and find your way over to the department. Then simply introduce yourself to one of the attendings (even better if they've given a med student lecture, but not critical) and tell them you are interested in seeing more of XYZ specialty and ask if there's a good time, either now or another time, for you to shadow them or one of their associates. At a teaching hospital, they should see this as part of their job, or at least pawn you off on a resident/fellow in the field. If they don't, you just find someone else.

In terms of when to do this, I would suggest waiting until at least halfway through first year, because honestly you have enough to worry about getting into the swing of first year before that.

 

[PTPoeny]

Ugh, maybe I just had bad luck then - maybe 1/10 or less returned my call/emails. Same process in med school? That's a little bit annoying.

At least at my school we had to do shadowing on a regular basis through first and second year so the attendings at the medical school are used to getting students emailing them. Plus the different student interest groups keep lists of attendings that really enjoy having students shadowing so you can email people that you know enjoy having students with them.

FWIW, I have only once had an attending say no when I emailed them about shadowing and that was because she was leaving in two days for maternity leave and I had to do my shadowing before she got back.

 

[cpants]

1. yes
2. no
3. hospital
4. NO!!!
5. I dont care when I work....just dont want to work more than 50hrs.wk once I am an attending.

What am I?

A CRNA.

Seriously though....I would think about anethesia, EM, or one of the more lifestyle oriented surgical specialties like ENT, optho, or GU.

 

[Lokhtar]

ENT is a lifestyle oriented specialty? Weird, someone said it was completely the opposite.

 

[cpants]

ENT is a lifestyle oriented specialty? Weird, someone said it was completely the opposite.

It is after residency. All surgical residencies are difficult...long length and long hours. ENT attendings often enjoy a pretty sweet lifestyle. The most common procedures are short outpatient jobs and not a lot of call or emergencies.

 

[Lokhtar]

Ah - he was probably talking about residency (being a resident 😀).

 

[TobiasFunkeMDFACS]

How limited are your choices with a 194 or <200 score on the boards? Can you "reasonably" expect to match into any of these specialties:
gen. surgery
neurology
oncology

If not, what are you left with?

 

[alwaysaangel]

How limited are your choices with a 194 or <200 score on the boards? Can you "reasonably" expect to match into any of these specialties:
gen. surgery
neurology
oncology

If not, what are you left with?

G surg unlikely but possible if you are willing to go to the middle of no where.
Neurology is a failure non-competitive field so that would be doable. Again, you aren't going to be getting into highly rated programs or desirable locations.
Oncology is a fellowship in internal medicine. Internal medicine is very doable with a score like that (in a lower competitive program/undesirable location). However most IM fellowships are relatively competitive so it may hurt you when applying for the onc fellowship.

Probably best thing to do is redeem yourself by doing well on Step 2.

 

[cowme]

I'll be starting med school soon and thankfully I don't have to decide for four years what I want to do, but I'm wondering what the usual process is? I mean right now, I don't think I have any clue and I'm guessing most people don't have an idea until their third or fourth year? Obviously you could want dermatology as a pre-med but if you get a 194 on your Step I, it's going to be difficult...or you could do a rotation and hate the specialty.

But there are many specialties that you don't rotate through your third or fourth years...so you may not think you're interested but if you had only tried it, maybe that was the one you would have fell in love with. So I'm wondering how you guys (3rd and 4th years, residents, etc) decided? Process of elimination? Did you guys shadow during your first and second years? Anyone have a 'Aha!' moment, maybe too late?

 

[Geekchick921]

I still think there needs to be another line off Attention Span that just says, "Teehee, genitals!" Or "Significant" to "Head" (for Psych) and "Genitals". Then, "Would rather look at vagina" -> Ob/Gyn and "Would rather look at penis" -> Urology.

 

[TobiasFunkeMDFACS]

Do you get paid less as an attending if you attend a less prestegious residency program or go to one in the middle of nowhere. I would assume that with standard pay rates for procedures, insurance companies would pay all gen. surgeons equally, all oncologists equally etc.

I see the real value of going to a better program (to be a better doctor), but would it negatively effect the economic side of your clinical practice?

 

[obgyny]

G surg unlikely but possible if you are willing to go to the middle of no where.
Neurology is a failure non-competitive field so that would be doable. Again, you aren't going to be getting into highly rated programs or desirable locations.
Oncology is a fellowship in internal medicine. Internal medicine is very doable with a score like that (in a lower competitive program/undesirable location). However most IM fellowships are relatively competitive so it may hurt you when applying for the onc fellowship.

Probably best thing to do is redeem yourself by doing well on Step 2.

What did you mean by the bold? For some reason that phrase isn't registering with me .

 

[cowme]

Do you get paid less as an attending if you attend a less prestegious residency program or go to one in the middle of nowhere. I would assume that with standard pay rates for procedures, insurance companies would pay all gen. surgeons equally, all oncologists equally etc.

I see the real value of going to a better program (to be a better doctor), but would it negatively effect the economic side of your clinical practice?

This is a very complex question, but there are a couple points.
- Academic docs make less than those in Private practice, generally
- Residency at a harvard hospital may look great to land that academic position, but if all you want to do is operate at your local community hospital, your salary will be the same no matter where you trained.
- In tough job markets, a big name may give you the edge for some top jobs, but overall, this is far less important than your performance as a resident.
- Going to a bigger name may not necessarily translate into being a "better doctor" as you imply. For instance, some of the biggest names in orthopedic surgery you may get only half of the OR experience as somebody who trains at a community hospital in the boonies. For instance, top hospitals have often have a crapload of fellows and private patients. In addition, a lot of cases are very rare bone tumors, etc that a normal private practice ortho would never operate on anyways, as they would refer it to academic large centers. Compare this environment to the resident who trains in a place with no fellows in a small residency class seeing twice as many cases....who do you think will be better suited for a run of the mill job in a local hospital?

When you pick residency, you really have to decide what you want. A lot of med students lie their asses off saying they want to go into academics (when in reality, ~80% go into PP) because they strive for that top name, but sometimes this ego may actually interfere with what will really provide the best training. But again...this is very specialty dependent.

 

[Geekchick921]

What did you mean by the bold? For some reason that phrase isn't registering with me .

My guess is that he meant to type "fairly" and his phone or iPad autocorrected it. Ha!

 

[obgyny]

This is a very complex question, but there are a couple points.
- Academic docs make less than those in Private practice, generally
- Residency at a harvard hospital may look great to land that academic position, but if all you want to do is operate at your local community hospital, your salary will be the same no matter where you trained.
- In tough job markets, a big name may give you the edge for some top jobs, but overall, this is far less important than your performance as a resident.
- Going to a bigger name may not necessarily translate into being a "better doctor" as you imply. For instance, some of the biggest names in orthopedic surgery you may get only half of the OR experience as somebody who trains at a community hospital in the boonies. For instance, top hospitals have often have a crapload of fellows and private patients. In addition, a lot of cases are very rare bone tumors, etc that a normal private practice ortho would never operate on anyways, as they would refer it to academic large centers. Compare this environment to the resident who trains in a place with no fellows in a small residency class seeing twice as many cases....who do you think will be better suited for a run of the mill job in a local hospital?

When you pick residency, you really have to decide what you want. A lot of med students lie their asses off saying they want to go into academics (when in reality, ~80% go into PP) because they strive for that top name, but sometimes this ego may actually interfere with what will really provide the best training. But again...this is very specialty dependent.

I haven't looked into this because it's so far away (starting med school in the fall), but when you're applying for attending positions, what are they looking for (either Academic Medicine or community hospital position)? For residency, they look at your clinical grades/evaluations, LORs, research, board scores, etc, but what about attendings? Are there evaluations in residency that an employer would have access to? Do they look at all 3 of your board scores (if so, do they weigh all 3 steps equally?)? Especially for Academic Medicine, do they still want to see publications throughout residency?

I know I've still got a ways until I have to worry about this, but I'm just curious how it works.

My guess is that he meant to type "fairly" and his phone or iPad autocorrected it. Ha!

Oh okay 🙂... I was like "failure non-competitive" 😕 ... means "failed to be non-competitive, and thus competitive?"

 

[cowme]

You will have a choice out of residency to pursue an academic position ( ie, employed by a university hospital system---you will be doctor, but do research and teach students in addition), or pursue a community hospital /private practice position (ie focus on only work, no research, teaching bs to put up with).

When you apply for an academic position, your cv, research and references are all extremely important. For any other job, pretty much all that matters is who you know and your references.

 

[obgyny]

You will have a choice out of residency to pursue an academic position ( ie, employed by a university hospital system---you will be doctor, but do research and teach students in addition), or pursue a community hospital /private practice position (ie focus on only work, no research, teaching bs to put up with).

When you apply for an academic position, your cv, research and references are all extremely important. For any other job, pretty much all that matters is who you know and your references.

Thanks for clearing that up, makes sense 🙂.

 

[DrBowtie]

Besides learning the basics of medicine, the most important thing you'll do in med school is decide what field to go into. IMO that's also the hardest task.

As someone who was dead set on a field going in and had thought it through with very valid reasons, I still found committing to a field very tough. I'll be applying in rads, but I really like surgery a lot. Honestly, if there's fields you're interested in, try to shadow or do electives, you may like them more or less than you think. 3rd year is when you're really going to figure things out, though.

In terms of overall strategy, I'd try to decide 1) if you want to do procedures 2) if you want continuity of care 3) If you like working in a Hosp or clinic more 4) if you like rounds 5) what lifestyle are you comfortable with.

In the end, I'm going to do prelim Surg then rads, which I think will be nice.

Almost my exact same thought process. Although I think I've settled on trying to snag a TY before going to a surg prelim year.

 

[shaggy alfresco]

So the consensus is to shadow people in the first 2 years and hopefully go into 3rd year with a slightly better idea (and by that time you'd have some idea of your competitiveness?)

 

[Reductio]

So the consensus is to shadow people in the first 2 years and hopefully go into 3rd year with a slightly better idea (and by that time you'd have some idea of your competitiveness?)

No, not really the consensus. Shadowing is a very pre-med idea, and lots of med students do not do it. Shadowing a doc actually gives you a rather biased view of the specialty. What you'll come away with can be mostly a product how that particular doctor went through his days - did he seem happy, busy, content, challenged, bored, rushed, annoyed, stressed....? The real practice of medicine happens inside the attendings brain - and thats something you really cant observe. Unless, the doc is particularly talkative, and then you'll have another bias altogether.

I think that the countless threads on the SDN about residents and attendings hating their job and wanting out is a often a product of early unrealistic ideas of a specialty, followed by a LOT of hard work to get into that specialty, followed by a huge disappointment in said specialty, and a feeling that all the hard work was wasted.

Why's that? Because again, many if not most of us get our impressions from an overall feeling - a gestalt. And oftentimes, those impressions come not from the specialty itself, but how much we liked the attending's personality. Yet we wrongly attribute those good feelings to the specialty itself. I really think shadowing can do more harm than good - either steering you towards or away from a specialty. This is especially true the earlier one is in their medical training - the less medicine you've experienced, the more the personality of the attending will sway you. This happens to MS-3 and 4 students as well, but by that point, hopefully you have some maturity to realize that its happening.

Its like a bad relationship... the initial attraction came from money or looks, or even a really outgoing exciting personality... not from the substance. Once youre locked into a specialty - especially if you start preparing for it early on - its tough to convince yourself that it isnt right for you.

I think the flow chart posted by Cowme is a better way to choose a specialty than to shadow docs in your pre-clinical years.

I think the best thing that you can do for yourself is look at your pre-clinicals and decide what you liked and didnt like. THAT can give you a SIGNIFICANTLY more clear idea of what to do into than the countless threads which begin :
"I want a specialty which has a wide variety of patients, good hours, lots of money, and no clinic"

If you think to yourself: I want a specialty that deals heavily on physio and pharm. I hated memorizing anatomy - then go for medicine, peds, gas, etc.

If you liked a bit of everything, but not anything in particular because you'd rather be a clinician - EM, FP, OB/Gyn

If you think: I didnt like physio or pharm, but i liked anatomy and microbio then think of pathology, surgery,

No matter what they try to tell you - you dont have to know a ton of anatomy and microbio for medicine peds pr family.

And no matter what they try to tell you - you do not need to know a ton of physio and pharm to do surgery, path, or rads.

If you separate out the specialties in those general terms, and base your decisions on what you know you gravitate towards, and what you know youre good at - I guarantee that you wont be back on the SDN begging for advice on how to leave clinical medicine.

 

[xanthomondo]

No, not really the consensus. Shadowing is a very pre-med idea, and lots of med students do not do it. Shadowing a doc actually gives you a rather biased view of the specialty. What you'll come away with can be mostly a product how that particular doctor went through his days - did he seem happy, busy, content, challenged, bored, rushed, annoyed, stressed....? The real practice of medicine happens inside the attendings brain - and thats something you really cant observe. Unless, the doc is particularly talkative, and then you'll have another bias altogether.

I think that the countless threads on the SDN about residents and attendings hating their job and wanting out is a often a product of early unrealistic ideas of a specialty, followed by a LOT of hard work to get into that specialty, followed by a huge disappointment in said specialty, and a feeling that all the hard work was wasted.

Why's that? Because again, many if not most of us get our impressions from an overall feeling - a gestalt. And oftentimes, those impressions come not from the specialty itself, but how much we liked the attending's personality. Yet we wrongly attribute those good feelings to the specialty itself. I really think shadowing can do more harm than good - either steering you towards or away from a specialty. This is especially true the earlier one is in their medical training - the less medicine you've experienced, the more the personality of the attending will sway you. This happens to MS-3 and 4 students as well, but by that point, hopefully you have some maturity to realize that its happening.

Its like a bad relationship... the initial attraction came from money or looks, or even a really outgoing exciting personality... not from the substance. Once youre locked into a specialty - especially if you start preparing for it early on - its tough to convince yourself that it isnt right for you.

I think the flow chart posted by Cowme is a better way to choose a specialty than to shadow docs in your pre-clinical years.

I think the best thing that you can do for yourself is look at your pre-clinicals and decide what you liked and didnt like. THAT can give you a SIGNIFICANTLY more clear idea of what to do into than the countless threads which begin :
"I want a specialty which has a wide variety of patients, good hours, lots of money, and no clinic"

If you think to yourself: I want a specialty that deals heavily on physio and pharm. I hated memorizing anatomy - then go for medicine, peds, gas, etc.

If you liked a bit of everything, but not anything in particular because you'd rather be a clinician - EM, FP, OB/Gyn

If you think: I didnt like physio or pharm, but i liked anatomy and microbio then think of pathology, surgery,

No matter what they try to tell you - you dont have to know a ton of anatomy and microbio for medicine peds pr family.

And no matter what they try to tell you - you do not need to know a ton of physio and pharm to do surgery, path, or rads.

If you separate out the specialties in those general terms, and base your decisions on what you know you gravitate towards, and what you know youre good at - I guarantee that you wont be back on the SDN begging for advice on how to leave clinical medicine.

But what about all of the specialties that you get absolutely NO exposure to during med school?

Rad onc? PMnR? Ophtho? Rads? ER?

 

[Reductio]

But what about all of the specialties that you get absolutely NO exposure to during med school?

Rad onc? PMnR? Ophtho? Rads? ER?

if it's something that I've had zero exposure to in med school. (My only exposure to PM&R was taking the time to read a lengthy consult on a patient of mine). I won't choose it, and still be perfectly happy with my decision. I dont have to try everything at the buffet to know that I really like the kung po chicken and can eat that every day of the week.

Other things, that ive had some exposure to (ER - from the many admits from my core IM rotation, consults for core OB, and full shifts during core Peds), to know if I'd like to try an elective in it, or even go for as a career.

Then theres the ones in the middle - like Radonc, or Rads - Where you bump into an attending here and there on related rotations. If you're proactive, you can chat with them about whatever patient initiated the bumping-into. See how they think, what they think, and what their role is in the care of your patient. That should give you an idea if its worth perusing further.

But either way... you need to be proactive, keep your eyes open, and use your brain. On reading my only PM&R consult, I found that those docs know anatomy better than Gray himself... so I can extrapolate
like anatomy and neuroscience - think of pm&r
like anatomy, hate patients - radiology
like anatomy, and college physics - rad onc
like everything, have ADD -- ER
like neuroscience, anatomy and physio of the eye - ophtho
like neuroscience - neurology
like psychology - psychiatry
maybe you developed an interest in a disease process... cancer, autimmune, infectious....
maybe you are into fittness, nutrition, and would rather deal with healthy people - try FP, sports, or OB.

just sit back, and think about what it is that you've been good at so far.

But the major point is. Its a buffet. Once you find something you can eat every day, theres nothing wrong with sticking to that. You dont need to experience every field to make an "informed, educated" decision about which is the best for you.

Sometime you all should talk to an old-timer doctor about how they chose their specialty. They didnt go pulling their hair out trying to decide. They picked up on just a few must-haves, and some dont-wants that were based in the specialty, not in variable things like money or call-schedule.... they just picked something and went with it.

I talked to an ophtho who chose it because he loved surgery and hated blood
-a doc who chose IM because he wanted to be a real doc, and Nephro fellowship because he liked chemistry.
- a doc who was applying for peds, hated to see babies suffering (as if people like that) - went IM at the very last minute.... now an interventional cardio
- a doc who became an FP only because he couldnt decide between Peds and EM.
All of them couldnt be happier with their choices.

The universe has its way of sorting things out. Enter a field for the "wrong" reasons, and you'll be miserable at worst, bored at best. If by the end of 3rd year, nothing - no basic science, and no core medical field has caught your interest... you must have entered medical school for the wrong reasons.

 

[cpants]

Shadowing as a med student is a lot different than shadowing as a premed. If you are enthusiastic and read up on what you are doing, they will actually let you do stuff in clinic, the OR, etc. Obviously, you have to take the experience for what it is: a very limited exposure to one or two docs in a field. That said, it is still valuable information to add to the puzzle.

You shouldn't be basing your career choice on a couple of days of shadowing, but it can be something that points you in the direction of a formal rotation in the field or gives you some idea of what you should do for research after M1. "Wow, I thought the OR was really cool, maybe I should try to get on a project with a surgeon or surgical subspecialist this summer."

Which subjects you liked in preclinical is important, but a lot less important than exposure to the field in question. Because you like pharm and physio DOES NOT mean you will like anesthesiology. You may like those aspects of anesthesia, but your day isn't really spent thinking that much about those things. What is more relevant is the content of your workday, the schedule, the culture, the type of patients you see, the practice environment, the ancillary staff you will interact with, the scope of practice.

 

[Freakfarm0]

if it's something that I've had zero exposure to in med school. (My only exposure to PM&R was taking the time to read a lengthy consult on a patient of mine). I won't choose it, and still be perfectly happy with my decision. I dont have to try everything at the buffet to know that I really like the kung po chicken and can eat that every day of the week.

Other things, that ive had some exposure to (ER - from the many admits from my core IM rotation, consults for core OB, and full shifts during core Peds), to know if I'd like to try an elective in it, or even go for as a career.

Then theres the ones in the middle - like Radonc, or Rads - Where you bump into an attending here and there on related rotations. If you're proactive, you can chat with them about whatever patient initiated the bumping-into. See how they think, what they think, and what their role is in the care of your patient. That should give you an idea if its worth perusing further.

But either way... you need to be proactive, keep your eyes open, and use your brain. On reading my only PM&R consult, I found that those docs know anatomy better than Gray himself... so I can extrapolate
like anatomy and neuroscience - think of pm&r
like anatomy, hate patients - radiology
like anatomy, and college physics - rad onc
like everything, have ADD -- ER
like neuroscience, anatomy and physio of the eye - ophtho
like neuroscience - neurology
like psychology - psychiatry
maybe you developed an interest in a disease process... cancer, autimmune, infectious....
maybe you are into fittness, nutrition, and would rather deal with healthy people - try FP, sports, or OB.

just sit back, and think about what it is that you've been good at so far.

But the major point is. Its a buffet. Once you find something you can eat every day, theres nothing wrong with sticking to that. You dont need to experience every field to make an "informed, educated" decision about which is the best for you.

Sometime you all should talk to an old-timer doctor about how they chose their specialty. They didnt go pulling their hair out trying to decide. They picked up on just a few must-haves, and some dont-wants that were based in the specialty, not in variable things like money or call-schedule.... they just picked something and went with it.

I talked to an ophtho who chose it because he loved surgery and hated blood
-a doc who chose IM because he wanted to be a real doc, and Nephro fellowship because he liked chemistry.
- a doc who was applying for peds, hated to see babies suffering (as if people like that) - went IM at the very last minute.... now an interventional cardio
- a doc who became an FP only because he couldnt decide between Peds and EM.
All of them couldnt be happier with their choices.

The universe has its way of sorting things out. Enter a field for the "wrong" reasons, and you'll be miserable at worst, bored at best. If by the end of 3rd year, nothing - no basic science, and no core medical field has caught your interest... you must have entered medical school for the wrong reasons.

Time to lock the thread, this is the only answer anyone needs to read.

Good posts. 👍

 

[MCAT guy]

Good posts by reductio

 

[Reductio]

Which subjects you liked in preclinical is important, but a lot less important than exposure to the field in question. Because you like pharm and physio DOES NOT mean you will like anesthesiology. You may like those aspects of anesthesia, but your day isn't really spent thinking that much about those things. What is more relevant is the content of your workday, the schedule, the culture, the type of patients you see, the practice environment, the ancillary staff you will interact with, the scope of practice.

And I am proposing that this is precisely what is IRRELEVANT. the content of your workday, schedule, culture, patient population, environment, ancillary staff, and scope, I argue, are what you should NOT worry about. Why? Because they vary drastically, within each specialty. Those are things that you MUST consider when you choose your job as an Attending. NOT, when you chose specialty.

Talk to old-timer docs who are passionate about their specialty. To the first bolded sentence above... sure, but it doesnt have to be that way. Talk to an experienced anesthesiologist who still gets giddy whenever he administers neostigmine. That stuff doesnt have to get old. The minute an anesthesiologist stops thinking about the physio and pharm, and starts giving meds as per protocol - he just demoted himself to a paramedic administering RSI, or a CRNA waking the patient up. Its the only "constant" in medicine - science I mean.

 

[cpants]

And I am proposing that this is precisely what is IRRELEVANT. the content of your workday, schedule, culture, patient population, environment, ancillary staff, and scope, I argue, are what you should NOT worry about. Why? Because they vary drastically, within each specialty. Those are things that you MUST consider when you choose your job as an Attending. NOT, when you chose specialty.

Sure there is variation within each specialty, but you would be hard pressed, for example, to find a transplant surgeon who never takes overnight call. As an attending, you don't just get to dictate what your job will be. The market and many of the aspects I mentioned above will dictate what your job will be like. These are the type of things that med students should think about now if they want to be happy in their careers twenty years from now. I guess we just disagree. I think a few days shadowing and later a formal rotation are much better ways to decide on a career than how you liked your anatomy or physiology class.

I think basic science interests are best used as a rule out than a rule in. I hated cellular biology and histopathology...path is out. That makes sense. I liked physiology and pharmacology, I will be an anesthesiologist...not so much. Preclinical interests are a good starting out point to look at fields which are heavy on those topics through clinical experiences, but should not be the basis of the choice. Almost every field in medicine incorporates the basic science subjects. You can focus more or less on basic science and your particular area of interest within most specialties.

 

[cowme]

Sure there is variation within each specialty, but you would be hard pressed, for example, to find a transplant surgeon who never takes overnight call. As an attending, you don't just get to dictate what your job will be. The market and many of the aspects I mentioned above will dictate what your job will be like. These are the type of things that med students should think about now if they want to be happy in their careers twenty years from now. I guess we just disagree. I think a few days shadowing and later a formal rotation are much better ways to decide on a career than how you liked your anatomy or physiology class.

I think basic science interests are best used as a rule out than a rule in. I hated cellular biology and histopathology...path is out. That makes sense. I liked physiology and pharmacology, I will be an anesthesiologist...not so much. Preclinical interests are a good starting out point to look at fields which are heavy on those topics through clinical experiences, but should not be the basis of the choice. Almost every field in medicine incorporates the basic science subjects. You can focus more or less on basic science and your particular area of interest within most specialties.

If you need some kind of. Idea for a summer research project, then yes, shadowing can help for that. Otherwise, it is completely pointless to use shadowing to pick a career (unless it's a formal, week long, "unofficial rotation" type shadowing)

 

[cpants]

If you need some kind of. Idea for a summer research project, then yes, shadowing can help for that. Otherwise, it is completely pointless to use shadowing to pick a career (unless it's a formal, week long, "unofficial rotation" type shadowing)

Obviously you don't do a few days of shadowing and pick your specialty. I wasn't suggesting that. It's a way to get an early exposure to a few specialties, making it easier to plan for what elective rotations you will do during the clinical years and what you might need to do to make yourself competitive for a specialty of interest.