How to decide between a large number of possible specialties

[neoevolution]

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I think my 4 most likely fields are medicine, neuro, psych, or radiology, but I'm concerned as to how to decide in time to apply for away rotations, especially as I won't have rotated on all of them by that point.

I've particularly enjoyed the inpatient experience on the rotations that I have had, and I'm wondering if I'll be dissatisfied if I get a job with significant outpatient work. I know there are inpatient-only jobs but I don't know how difficult those are to find. Do most IM or Neuro sub-specialties end up doing both?

Radiology seems really interesting to me, but I'm unsure about giving up the vast majority of patient contact to go that route. I'm also a little concerned about how "intense" it seems to be, in that the hours are decent but you're reading non-stop while at work and productivity is critical.

For psych, I've enjoyed in-patient and out-patient in a variety of settings, but I'm particularly concerned about the lack of overlap with medicine. I've seen my attending consult medicine over allergic conjunctivitis, and if that's the norm in the field, I would be a little disappointed in losing that knowledge base.

Medicine/neuro have the coolest physiology IMO, and I enjoy rounding and the differential and treatment process for in-patient, but out-patient seems a little dull and repetitive to me.

I think I would do a fellowship regardless of the field I go for, so overall length of training should be pretty similar. I know radiology/psych would have better lifestyle during residency but that's not a huge concern for me. The lifestyle of psych and income of radiology after residency are appealing, but I don't think it's enough to sway my decision either. I'd say my stats overall are somewhat above average but not stellar, so I think I should be ok for a decent academic program in the fields I'm considering.

 

[Osteoth]

I think my 4 most likely fields are medicine, neuro, psych, or radiology, but I'm concerned as to how to decide in time to apply for away rotations, especially as I won't have rotated on all of them by that point.

I've particularly enjoyed the inpatient experience on the rotations that I have had, and I'm wondering if I'll be dissatisfied if I get a job with significant outpatient work. I know there are inpatient-only jobs but I don't know how difficult those are to find. Do most IM or Neuro sub-specialties end up doing both?

Radiology seems really interesting to me, but I'm unsure about giving up the vast majority of patient contact to go that route. I'm also a little concerned about how "intense" it seems to be, in that the hours are decent but you're reading non-stop while at work and productivity is critical.

For psych, I've enjoyed in-patient and out-patient in a variety of settings, but I'm particularly concerned about the lack of overlap with medicine. I've seen my attending consult medicine over allergic conjunctivitis, and if that's the norm in the field, I would be a little disappointed in losing that knowledge base.

Medicine/neuro have the coolest physiology IMO, and I enjoy rounding and the differential and treatment process for in-patient, but out-patient seems a little dull and repetitive to me.

I think I would do a fellowship regardless of the field I go for, so overall length of training should be pretty similar. I know radiology/psych would have better lifestyle during residency but that's not a huge concern for me. The lifestyle of psych and income of radiology after residency are appealing, but I don't think it's enough to sway my decision either. I'd say my stats overall are somewhat above average but not stellar, so I think I should be ok for a decent academic program in the fields I'm considering.

What is the most important factor when choosing your specialty? A senior asked me that question when I was thinking about this as a first year and I think it resonated well with me. Medicine is a field of hyper-specialization, you get to pick one thing that's awesome and then thats what you're going to do forever.

So if you like inpatient medicine, like dealing with patients, like physiology & diagnosis, then medicine/neuro could be for you. From what I know neuro has much more out-patient than medicine, so that seems like it would be knocked out of consideration.

Radiology/psychiatry you aren't really a doctor once you start that residency, you're a radiologist/psychiatrist. Their specialties are so outside the main stream of medicine you will lose clinical diagnostic skills outside of your area, thats just a fact of the matter. Most doctors outside of medicine/FM lose some of it as they progress down their career pathways. Hell most people forget stuff from their own specialty as they get older.

 

[neoevolution]

What is the most important factor when choosing your specialty? A senior asked me that question when I was thinking about this as a first year and I think it resonated well with me. Medicine is a field of hyper-specialization, you get to pick one thing that's awesome and then thats what you're going to do forever.

So if you like inpatient medicine, like dealing with patients, like physiology & diagnosis, then medicine/neuro could be for you. From what I know neuro has much more out-patient than medicine, so that seems like it would be knocked out of consideration.

Radiology/psychiatry you aren't really a doctor once you start that residency, you're a radiologist/psychiatrist. Their specialties are so outside the main stream of medicine you will lose clinical diagnostic skills outside of your area, thats just a fact of the matter. Most doctors outside of medicine/FM lose some of it as they progress down their career pathways. Hell most people forget stuff from their own specialty as they get older.

I think psych has the draw for me in that the psych exam is really interesting as are the personalities/behaviors of a lot of the patients. It's definitely less "mainstream" than med/neuro though, and I do wonder if I would miss that down the road. But I loved the process of diagnosis and treatment on both in-patient and out-patient for psych. I think IM/psych is really competitive and niche, but I was wondering if psychosomatic fellowship might give the combo of some psych and medicine I think I'd be interested in.

I think radiology might be too different for me in that regard. The minimal patient contact doesn't seem particularly engaging to me.

 

[Tenk]

I think my 4 most likely fields are medicine, neuro, psych, or radiology, but I'm concerned as to how to decide in time to apply for away rotations, especially as I won't have rotated on all of them by that point.

I've particularly enjoyed the inpatient experience on the rotations that I have had, and I'm wondering if I'll be dissatisfied if I get a job with significant outpatient work. I know there are inpatient-only jobs but I don't know how difficult those are to find. Do most IM or Neuro sub-specialties end up doing both?

Radiology seems really interesting to me, but I'm unsure about giving up the vast majority of patient contact to go that route. I'm also a little concerned about how "intense" it seems to be, in that the hours are decent but you're reading non-stop while at work and productivity is critical.

For psych, I've enjoyed in-patient and out-patient in a variety of settings, but I'm particularly concerned about the lack of overlap with medicine. I've seen my attending consult medicine over allergic conjunctivitis, and if that's the norm in the field, I would be a little disappointed in losing that knowledge base.

Medicine/neuro have the coolest physiology IMO, and I enjoy rounding and the differential and treatment process for in-patient, but out-patient seems a little dull and repetitive to me.

I think I would do a fellowship regardless of the field I go for, so overall length of training should be pretty similar. I know radiology/psych would have better lifestyle during residency but that's not a huge concern for me. The lifestyle of psych and income of radiology after residency are appealing, but I don't think it's enough to sway my decision either. I'd say my stats overall are somewhat above average but not stellar, so I think I should be ok for a decent academic program in the fields I'm considering.

Become a hospitalist. No call. No outpatient. Only work half the month. Decent pay. Only 3 years of residency.

Work is hard but you can have a good lifestyle. You just have to have a “we’ll take them” attitude and your life will be great. It’s the hospitalists that fight every single admission that seem to be miserable twats.

 

[neoevolution]

Become a hospitalist. No call. No outpatient. Only work half the month. Decent pay. Only 3 years of residency.

Work is hard but you can have a good lifestyle. You just have to have a “we’ll take them” attitude and your life will be great. It’s the hospitalists that fight every single admission that seem to be miserable twats.

I forgot to mention this, but I'm drawn to the idea of being a specialist in particular, so I would plan for a fellowship if I went with IM. It's one of the reasons why I think EM would be a bad fit for me.

 

[CaptainSSO]

I think psych has the draw for me in that the psych exam is really interesting as are the personalities/behaviors of a lot of the patients. It's definitely less "mainstream" than med/neuro though, and I do wonder if I would miss that down the road. But I loved the process of diagnosis and treatment on both in-patient and out-patient for psych. I think IM/psych is really competitive and niche, but I was wondering if psychosomatic fellowship might give the combo of some psych and medicine I think I'd be interested in.

I think radiology might be too different for me in that regard. The minimal patient contact doesn't seem particularly engaging to me.

IR and breast both have constant patient contact, so you don’t have to rule out radiology for that reason if you like it.

 

[Anti-PD1]

Do neurocritical care. You are the medicine team for acute neuro stuff, you read brain scans all day (yes he's herniating), no outpatient.

You work your arse off, but you make a lot of decisions in a short period of time, and there are occasional good outcomes.

 

[Tenk]

I forgot to mention this, but I'm drawn to the idea of being a specialist in particular, so I would plan for a fellowship if I went with IM. It's one of the reasons why I think EM would be a bad fit for me.

Hospitalist =/= EM. Also, if you work in a smaller hospital as a hospitalist you can do crit care, intubations, central lines, taps, and whatever else you feel confortable doing. Pretty much all specialists have robust clinics (which you did not seem thrilled about) though whereas a hospitalist does not.

 

[Atom612]

Hospitalist =/= EM. Also, if you work in a smaller hospital as a hospitalist you can do crit care, intubations, central lines, taps, and whatever else you feel confortable doing. Pretty much all specialists have robust clinics (which you did not seem thrilled about) though whereas a hospitalist does not.

Can a hospitalist still insist on being paid based off RVUs? Or are they pushed to become salary-based?

 

[Tenk]

Can a hospitalist still insist on being paid based off RVUs? Or are they pushed to become salary-based?

That just depends on your contract and who you are working for: ie corporation, locums, group or hospital.

 

[neoevolution]

Pretty much all specialists have robust clinics (which you did not seem thrilled about) though whereas a hospitalist does not.

Are there not many in-patient only jobs for IM specialists? I was under the impression that in psych that was usually possible.

 

[Tenk]

Are there not many in-patient only jobs for IM specialists? I was under the impression that in psych that was usually possible.

Dunno about psych. The only IM subspecialty I can think of where you can do total inpatient is crit care. Pretty much all the other ones need a clinic to thrive.

 

[neoevolution]

Dunno about psych. The only IM subspecialty I can think of where you can do total inpatient is crit care. Pretty much all the other ones need a clinic to thrive.

Ahh ok. Honestly, maybe a blend of inpatient and outpatient would be something I'd like. But I thought family medicine outpatient was insanely dull and referred all the cool stuff out. Maybe being referred the cool stuff would be more interesting, but I don't know how much variety there is in some of the sub-specialties. Hypertension and diabetes were pretty repetitive in FM, and I don't know if endocrine outpatient, for example, would be similarly repetitive but with diabetes and hypothyroidism instead.

Is there a decent way to scope out the IM subspecialties if I don't get to rotate on them this year? Should I look into shadowing on days off from rotation?

 

[doc05]

Based on your posts, I don't think you've had enough exposure to any of your specialties of interest. Your impressions of those fields are superficial. You need to learn more or you'll be sorely disappointed with whatever choice you make.

 

[Redpancreas]

I think my 4 most likely fields are medicine, neuro, psych, or radiology, but I'm concerned as to how to decide in time to apply for away rotations, especially as I won't have rotated on all of them by that point.

I've particularly enjoyed the inpatient experience on the rotations that I have had, and I'm wondering if I'll be dissatisfied if I get a job with significant outpatient work. I know there are inpatient-only jobs but I don't know how difficult those are to find. Do most IM or Neuro sub-specialties end up doing both?

Radiology seems really interesting to me, but I'm unsure about giving up the vast majority of patient contact to go that route. I'm also a little concerned about how "intense" it seems to be, in that the hours are decent but you're reading non-stop while at work and productivity is critical.

For psych, I've enjoyed in-patient and out-patient in a variety of settings, but I'm particularly concerned about the lack of overlap with medicine. I've seen my attending consult medicine over allergic conjunctivitis, and if that's the norm in the field, I would be a little disappointed in losing that knowledge base.

Medicine/neuro have the coolest physiology IMO, and I enjoy rounding and the differential and treatment process for in-patient, but out-patient seems a little dull and repetitive to me.

I think I would do a fellowship regardless of the field I go for, so overall length of training should be pretty similar. I know radiology/psych would have better lifestyle during residency but that's not a huge concern for me. The lifestyle of psych and income of radiology after residency are appealing, but I don't think it's enough to sway my decision either. I'd say my stats overall are somewhat above average but not stellar, so I think I should be ok for a decent academic program in the fields I'm considering.

To start, you need to decide surgical vs. non-surgical. It sounds like you've decided non-surgical. From there, it's inevitably your gut feelings and preconceived notions which draw you to a field. IM and Neurology are very similar tasks (managing exacerbations of chronic conditions, titrating meds, having a good knowledge base, etc.) while Neurology has the advantage of focusing on one area with a great deal of imaging involved these days. Psychiatry is highly variable. I've rotated with some who like to bring in the medicine and will go out of their way to deal with common ambulatory issues as well, but then others who will leave that to others. Don't really have much to say about Rads. Going back to IM and Neurology, both have a plethora of IP/OP roles so your IP preferences doesn't mean much. For IM, PCCM seems largely inpatient while others are a spectrum and General IM can be tailored to however you want it. For Neurology, there's lots of inpatient consults. Seizure meds lvls. can run low, immunomodulators can cause neurotoxicity, delirium's common, and of course there's all the classic Neurological disorders can have acute exacerbations. There's also have a significant outpatient role for chronic disorders like MS where you'll be monitoring progression and titrating medications.

Since I'm applying to IM, I'll say that most advisors in the field (here and my own) don't have amazing things to say about away rotations. Unless you want to network or really want to go to XYZ residency, there's no point as IM is a larger field and an away rotation isn't traditionally viewed as an "audition". It definitely won't make up lesser Steps or medical school performance. Connections and mentors will always play a role, but you don't have to deal with that as much with Medical School --> IM as opposed to Medical School --> small surgical subspecialties, for example. Even if you want to go to do an away rotation in order to match there, the odds are slightly stacked against you as it's a new city, EMR, culture, etc. that you'll be dealing which may not allow you to showcase your best efforts in the short time you'll have there.

 

[Redpancreas]

Ahh ok. Honestly, maybe a blend of inpatient and outpatient would be something I'd like. But I thought family medicine outpatient was insanely dull and referred all the cool stuff out. Maybe being referred the cool stuff would be more interesting, but I don't know how much variety there is in some of the sub-specialties. Hypertension and diabetes were pretty repetitive in FM, and I don't know if endocrine outpatient, for example, would be similarly repetitive but with diabetes and hypothyroidism instead.

Is there a decent way to scope out the IM subspecialties if I don't get to rotate on them this year? Should I look into shadowing on days off from rotation?

For IM, it's all about being a generalist before a specialist. If you like having a broad knowledge base and using physiology to solve clinical scenarios, you'll probably like IM and should apply. One thing that's a bit off-putting about your posts is your unrefined understanding of specialties as a whole (family = "dull, repetitive" work). You should have definitely had more than 1 rotation by now. Haven't you realized that all fields have a bread & butter? While Family may refer to Endocrinology, that doctor's going to deal with the same few conditions every day. You also don't need to scope out all IM subspecialties before you pick IM. It's never going to be a match made in heaven. Take a leap of faith on the basis that you like having a broad knowledge base and physiology and apply IM with 1 or 2 subspecialties in mind that you'll have time to explore and work towards during 4th year. If you don't like them, there's still about about dozen to choose from and if you don't like any, you'll still be content as an Internist because you like IM.

 

[neoevolution]

For IM, it's all about being a generalist before a specialist. If you like having a broad knowledge base and using physiology to solve clinical scenarios, you'll probably like IM and should apply. One thing that's a bit off-putting about your posts is your unrefined understanding of specialties as a whole (family = "dull, repetitive" work). You should have definitely had more than 1 rotation by now. Haven't you realized that all fields have a bread & butter? While Family may refer to Endocrinology, that doctor's going to deal with the same few conditions every day. You also don't need to scope out all IM subspecialties before you pick IM. It's never going to be a match made in heaven. Take a leap of faith on the basis that you like having a broad knowledge base and physiology and apply IM with 1 or 2 subspecialties in mind that you'll have time to explore and work towards during 4th year. If you don't like them, there's still about about dozen to choose from and if you don't like any, you'll still be content as an Internist because you like IM.

I'm about halfway through M3 currently, but FM was my only outpatient only rotation, and it's honestly the one that's been the least interesting to me so far. I think broad knowledge base is part of why I would like IM, but my issue is that I haven't actually rotated on all of the fields I think I might like but our school is encouraging us to commit to one before I will.