How to pick a specialty if you didn't like any of your rotations

[Pure Anergy]

Just wondering if anyone can give me some advice because I'm feeling kind of down about things right now. I'm an M3 almost halfway done with my clerkships. I came into medical school thinking that I'd do medicine, but so far it's been the rotation that I have hated the most. I'd actually rather not be a physician at all than go into medicine (sorry in advance to those of you who are in medicine and love it 😳 ) It doesn't help that all of the students rotating with me love medicine like crazy and want to do it. It also isn't related to the rotation itself, because my team is awesome. My attending is super nice, my intern spends a lot of time teaching me and helping prepare me so that I will look good on rounds, and in general everyone else in the whole department is just as nice as can be. Even residents on other teams have taken time to teach me things if they have an interesting patient or they're teaching their own students. But I still hate everything about it except actually seeing patients. I hate going on rounds for hours and hours with the team every day. I hate all the call we have to take and I'm sure that being super tired all the time has a lot to do with why I'm so miserable. I really hate doing the scut work, but I do it because my intern is super nice and I want to help him in return, and plus it's my job to help.

Maybe you're thinking, well, do something else instead if you hate medicine so much. But the problem is, I haven't wanted to do ANY of the specialties I've rotated in so far. They all have their positives and negatives, and it's not that I've hated all of them. But I can't see myself spending the next forty years of my life doing any of them. None of them really excite me all that much. I know that I still have half the rotations to go and maybe I'll just miraculously love something eventually, but I'm starting to think that I probably shouldn't do a residency at all. There's not anything I've done that I think I could do for the rest of my life. I feel like I'm just trying to endure it all and I always feel like I can't wait for every rotation to be over.

If it helps, these are things that I do like about my rotations. I like working with patients. That's about the only thing that has made my medicine rotation bearable (besides that the team is super nice and I really am learning a lot). So no rads or path or anything like that for sure. I like being active and doing things. Even though surgery was longer hours and I'd never want to live that lifestyle, I still liked it better than medicine because at least the time went by fast and I was always so busy. And if I wasn't busy I was so tired that I'd fall asleep the second I stopped moving. I like spending time with patients and getting to know them. I don't really see myself doing something like EM for that reason, although I haven't done that rotation yet so who knows. But I also don't think I'd like family medicine as a career because you're always so rushed. Every slot is 15 minutes and you see a couple dozen patients every day. I felt kind of stressed even though that is supposed to be an easier rotation, and it really wasn't fun because of that.

Do you think there is anything that might be a good fit? Or maybe I should look for something outside of clinical practice? I have done some research and didn't hate it, but again, I am not really enthusiastic about spending my whole life doing research either. I know a lot of people have problems picking between more than one specialty they love. What should someone do if they're not passionate about anything? 🙁

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[hippiedoc13]

I think it's way too soon to despair. You've done what, 3 or 4 rotations? Just because you haven't liked the 3 or 4 specialties you've experienced so far, doesn't mean there isn't something out there for you in the dozens of other specialties and sub-specialties. So keep hope alive.

There are many specialties that students get little or no exposure to during 3rd year, which makes it hard to know if one of those careers might be right for you. One thing you are already doing, which can be very helpful, is thinking about precisely what aspects you have liked and disliked about the specialties you have seen thus far. Also think about your interests and strengths. Then find out which specialties might be best suited to your particular likes/dislikes/interests, and try to set up some rotations in those specialties.

There are lots of people in the same boat as you...I had several friends in med school who confronted this situtation, and had to do some introspection and then deliberately looking outside the "core" 3rd year rotations to find the specialties that best fit them. Best of luck to you, I'm sure you'll find something that fits.

 

[Pure Anergy]

Thanks, hippiedoc. I've done seven required rotations so far. I have four more left plus some other requirements like AIs and selectives. I guess I'm just really disappointed because I thought I'd like medicine a lot and I don't. Anyway I have to finish the last rotations no matter what because I'm not going to drop out now that I'm this far along, and hopefully something will work out. I'm glad that your friends found specialties that they liked.

 

[dragonfly99]

If you don't like rounding forever then DON'T go into internal medicine.

If you like getting to know patients, you might like psych or neurology. Neurology has to do a medicine intern year, but then they do lots and lots of neuro. Patients tend to have chronic diseases so you'd get to know them. Also, if you do private practice later, you can choose to do a lot of outpatient medicine and not so much inpatient. My impression is neuro docs aren't quite as rushed as family practice or primary care IM, since they don't have to see as many patients/day to make a profit.

You also might like physical medicine/rehab.

If you liked surgery, and you like being busy, you might like ER. No rounding involved there, and not as much paperwork. You don't get to know your patients long term, but you get lots of patient interaction...

You might like optho?

Just some ideas.

No specialty is perfect. No job is perfect. Also, realize that you might feel differently if you had more of a role. I didn't like 3rd year either because I felt stupid and like I was just a spare part... i.e. nobody really relies on your decisions for anything. I felt like I was in junior high, probably b/c I'd had a real job before med school and it was hard to adjust to being a student again.

 

[Samoa]

Well, if I hadn't been right about what I wanted to do, I'd have been in exactly your situation. I was pretty lukewarm about, or else utterly hated, all my other rotations in med school.

And it's a little disturbing, as well, to realize that if I hadn't had exposure before med school, I might never even have rotated in the specialty I've chosen. And yet, when I finally did get to rotate on it, it was like the sun finally coming out after months of rain.

So I guess what I'm saying, in addition to the excellent advice above, and the excellent approach you're already taking toward the problem, is: don't despair of ever finding the right field, just because you don't really like anything so far. And don't cross off all the subspecialties of a field, just because you don't like the primary discipline. For example, in surgery (the field I'm most familiar with), the subspecialties each have a completely different personality from general surgery, and from each other, and it's common for people in the subspecialties to find nothing particularly engaging about the other surgical fields.

 

[Winged Scapula]

As Samoa notes consider a surgical subspecialty. You don't get much exposure to things like ENT, Ophtho, Uro, etc and they generally have significantly better lifestyles than general surgery, even in residency.

 

[michaelrack]

I don't have much to add, other than to say that private practice is a lot different from residency. Just because you hate a med school rotation doesn't mean that the next 40 years of your life will be miserable if you go into that specialty, just the next 3-7 years.

Even if you hate medicine rounding, you might love being a practicing internist.

However, in my opinion, 3-7 years of your life is too long to be doing something you hate.

 

[orientedtoself]

ent/ urology/ path/ rads/ anesthesia. check them out.

 

[docB]

Want to spend time getting to know patients and doing something active. How about PM&R.

 

[Ludicolo]

If you value spending time with patients and cultivating a relationship with them, then PM&R is certainly a valid option, especially if you are interested in the neuromusculoskeletal systems. Scut goes away as you move from intern to resident to attending. If you don't like feeling rushed, you may want to shy away from outpatient practice in general, since time constraints cut across all fields.

Start exploring some of these other specialties mentioned, you still have time to decide.

 

[Pure Anergy]

Thanks a lot for all of the suggestions. I went to talk to my advisor today and he pretty much agreed with what you said, which is that eventually I'll find something that I really like. He wants me to take the AAMC survey to help pick potential specialties based on your interests. Also, we picked several things that involve patient interaction and are active, like anesthesiology, heme/onc, and pain. I hadn't ever thought about PM & R before but I checked the catalog and we have a rotation in it, so I can try that too. I'll think about some of the surgical subspecialties, but I'm not sure I'd be competitive enough to get into them. I have good clinical grades and a respectable step 1 score but it's not amazing. But now at least I have some kind of plan and I can keep looking like all of you said. Thanks again, you've really been a huge help.

 

[ekydrd]

I'm thinkin' I have to agree with all the votes for PM&R. You get to know your patients well, help them get better, and go home feeling good about your self at the end of the day. AND no endless rounding for hours on end!

 

[IndyXRT]

I also found little I was excited about in my 3rd year rotations. Fortunately, I did a rotation in radiation oncology during the first month of my 4th year and loved it. Based on your comments above (liking surgery but not necessarily the hours and wanting to get to know your patients), it might be a good fit for you (although you would have to want to treat cancer patients almost exclusively). Just something else to consider.

 

[theKirk]

Oldie but still a goodie:

 

[Dejavu]

I know where you are coming from. I HATE ROUNDING with the white-hot passion of a thousand suns.

However, if you like the medicine part of Medicine, get yourself into an anesthesia residency. You will have to put up with the internship year, and all the rounding that that implies, but after that, the amount of rounding you have to do is limited to preop visits and postop visits. Well, maybe on your ICU rotations, but very minimal rounding.

But, you still get to use every thing you learned about medicine and still do lots of procedures as well. Plus, once you figure out what therapy your pt needs for a given OR situation, you give stuff that you see the effects of in minutes. You don't have to give a pill and then wait two weeks to see if it was a good idea.

Honest, anesthesia is right down your alley. Do it.

 

[Pure Anergy]

haha, thanks. I am going to try anesthesia for sure, and I'll look into rad onc too.

 

[Law2Doc]

haha, thanks. I am going to try anesthesia for sure, and I'll look into rad onc too.

Bear in mind that for both those paths you are generally going to have to do a year of residency in either medicine or surgery before you can start those paths, so I don't know how that comports with your professed hate of doing anything mediciny ever again. i also note that rad onc is one of the most competitive specialties, so since you indicated you weren't competitive for the surgical subspecialties, this may be out of reach as well.

 

[howelljolly]

http://www.med-ed.virginia.edu/specialties/


heres another test to see what might fit you. It ranks you into somewhere around 50 (if momory serves) specialties... including aerospace medicine. So, if nothing else, you'll see some fields youve never heard of.

 

[IndyXRT]

http://www.med-ed.virginia.edu/specialties/


heres another test to see what might fit you. It ranks you into somewhere around 50 (if momory serves) specialties... including aerospace medicine. So, if nothing else, you'll see some fields youve never heard of.

Interesting site. Apparently I missed out - radiation oncology (my specialty) was only #4 on my list (behind rheumatology, derm, and general internal medicine).

 

[howelljolly]

Who knows

I took the test before I started rotations, and have really liked what it said my Top 5 shoud be. And what Im applying for is in there. I took the test again just now, and its way off.

 

[jonb12997]

go figure... the uvirginia thing ranked pediatrics first, I had my first peds interview last week...

 

[Medikit]

I also found little I was excited about in my 3rd year rotations. Fortunately, I did a rotation in radiation oncology during the first month of my 4th year and loved it. Based on your comments above (liking surgery but not necessarily the hours and wanting to get to know your patients), it might be a good fit for you (although you would have to want to treat cancer patients almost exclusively). Just something else to consider.

I second Radiation Oncology, it's a great field. It is competitive though so if you have any interest I would seek out an adviser in that field asap.

 

[dragonfly99]

I don't think the little test works very well...it says I should do
either psych or plastic surgery... LOL! (I'm in one of the medical
subspecialties).
It's interesting, though.
I don't know, I scored almost the same on a bunch of different specialties...I guess this shows I'm all over the place?!

 

[fakin' the funk]

Want to spend time getting to know patients and doing something active. How about PM&R.

😱 Prescribing PT and braces counts as "active" ?

 

[BlondeDocteur]

I came to med school convinced I'd go into an IM specialty (ID). I took the test right before third year and the #1, by a landslide, was plastic surgery. I was disgusted with the thing and thought "if somehow this thing can take someone who spent years slogging through Africa working on infectious disease epidemics and think she'll be doing boob jobs on the Upper East Side, it's crazy."

Took it at the end of third year, when I was planning on gen surg-- same result. By a landslide.

Did my first plastics month in July... yup. Guess what I'm researching, and applying in next year? 🙂

(Though still not going to do boob jobs for the rich and famous.)

I don't think the little test works very well...it says I should do
either psych or plastic surgery... LOL! (I'm in one of the medical
subspecialties).
It's interesting, though.
I don't know, I scored almost the same on a bunch of different specialties...I guess this shows I'm all over the place?!

 

[Ludicolo]

I came to med school convinced I'd go into an IM specialty (ID). I took the test right before third year and the #1, by a landslide, was plastic surgery. I was disgusted with the thing and thought "if somehow this thing can take someone who spent years slogging through Africa working on infectious disease epidemics and think she'll be doing boob jobs on the Upper East Side, it's crazy."

Took it at the end of third year, when I was planning on gen surg-- same result. By a landslide.

Did my first plastics month in July... yup. Guess what I'm researching, and applying in next year? 🙂

(Though still not going to do boob jobs for the rich and famous.)

Never say never...

 

[Ludicolo]

😱 Prescribing PT and braces counts as "active" ?

🙄
We were doing so well...

 

[Pure Anergy]

Bear in mind that for both those paths you are generally going to have to do a year of residency in either medicine or surgery before you can start those paths, so I don't know how that comports with your professed hate of doing anything mediciny ever again. i also note that rad onc is one of the most competitive specialties, so since you indicated you weren't competitive for the surgical subspecialties, this may be out of reach as well.

I guess I'd have to do a surgery internship then since it's the lesser of two evils. I think you are right that I wouldn't be competitive for rad onc. I have a 232 on Step 1 and I'm in the top quartile of my class but not AOA. Those are respectable and good for many specialties but I'm below the average for rad onc.

 

[Pure Anergy]

http://www.med-ed.virginia.edu/specialties/


heres another test to see what might fit you. It ranks you into somewhere around 50 (if momory serves) specialties... including aerospace medicine. So, if nothing else, you'll see some fields youve never heard of.

haha I tried this and got aerospace medicine as my second choice. I think I agree with the people who are not too sure about this survey. It says I should go into preventive medicine. That's like public health and I had a hard time staying awake for those lectures if I showed up at all. Most of my other top choices were medicine subspecialties like renal, ID and rheum and somehow neurosurgery was third after preventive medicine and aerospace medicine. P M & R was number 12. Rad onc was in the middle. Anesthesiology and all of the surgical subspecialties came near the bottom.

 

[howelljolly]

I came to med school convinced I'd go into an IM specialty (ID). I took the test right before third year and the #1, by a landslide, was plastic surgery. I was disgusted with the thing and thought "if somehow this thing can take someone who spent years slogging through Africa working on infectious disease epidemics and think she'll be doing boob jobs on the Upper East Side, it's crazy."

Took it at the end of third year, when I was planning on gen surg-- same result. By a landslide.

Did my first plastics month in July... yup. Guess what I'm researching, and applying in next year? 🙂

(Though still not going to do boob jobs for the rich and famous.)

Why do you think that is?

 

[BlondeDocteur]

Going deep into the subconscious here...

I was fascinated by infectious diseases because I saw them as beautifully controllable systems. All of my clinical experiences before med school were in poor countries diagnosing and treating IDs alongside the docs/nurses. There was a good deal of problem-solving, but more importantly, there were immediate results. When I started shadowing the ID service in the hospital as a first year, I was disenchanted- where was the diagnostic sleuthing? All I saw was antibiotic approval requests and cookbook "check the culture sensitivities, prescribe the proper drug" interactions.

I started shadowing surgeons, and that really got my heart racing. My favorite preclinical class, by a landslide, was embryology-- I thought congenital pathology was absolutely fascinating. I therefore planned on a career in pediatric surgery, and when I rotated though surgery as an MS3, I knew beyond the shadow of a doubt that I was a "surgery person." That's what made me so effective doing public health fieldwork-- I was a take-charge, marshalling the troops type who worked long hours slogging around (it's really not easy, organizing entire villages and surveying them in a day, or simply hiring a driver, finding fuel and equipment, etc for a decrepit white Land Cruiser in the Sahel).

But in general surgery, something wasn't quite right. I kept feeling (apologies to all general surgeons) that the goal of the training was to learn to do specific operations, which had been proscribed in stone, and to learn to do them perfectly. I felt a bit like an automaton programming myself.

And then I did plastics. I loved that every case I saw represented active problem-solving. There was so much thinking on my feet. I also like that my judgments, analysis and thought processes as an individual mattered, much like they did in medicine, psychiatry and neurology. Pediatric plastics is an area that allows me to operate on and, hopefully through research, attempt to understand the congenital anomalies that I find so compelling.

My overriding passion is still international health. I know that's a gut roll-your-eyes response, but I think I'm the real deal in that respect. There's a spectrum, though, from the person who plans to live in a developing country and devote his/her entire practice to global medicine, to the policy person, to the 'weekend warrior' who does a volunteer trip or two. I've made my peace with the fact that family commitments mean I won't be the consultant travelling 4-6 months out of the year. I've picked a specialty that fascinates me, that will be enjoyable to practice in the US (seeing a child smile for the first time after a cleft lip repair is one of the more rewarding experiences I've had in medicine), and for which there is an enormous need internationally (many countries have no plastic surgeons, or 1: several million inhabitants, and the backlog of cases is huge).

Short answer long. 🙂

 

[howelljolly]

nice
thanks for the insight

 

[Substance]

Do derm.

You always have to problem solve. There are so many dermatologic diseases! It's not "nurse practitioner" territory like HTN, COPD, diabetes, "insert old-person disease here". It requires knowledge and sleuthing skill.

Of the diseases that are chronic and easier to diagnose, like acne and psoriasis, you can form lasting relationships with patients and observe the effects of your interventions over time. Seeing a 13 year old's face clear from acne, or helping a 23 year old girl feel sexy again because your treatment eliminated her huge ugly psoriatic plaques, is far more satisfying than getting someone's blood pressure down below 140/90, or someone's sugars down to normal levels.

There are no eternal rounds. Dermatologists and derm residents know that they're smart so they have no need to intellectually one-up their coworkers, unlike the medicine crowd. Also, unlike medicine, the bothersome social aspects of medicine like ADLs aren't focussed on.

You make enough money to take a bit more time with patients should you so choose. It's not like FM where you're rushed so that you can make ends meet.

Dermatologists are the happiest doctors I've met. They still love what they do after 30 years. It is intellectually and socially stimulating, and pays well, without making you sacrifice your entire life for it. Sounds like a good job to me.

Plus, your screen name makes it sound as if you are an immunology nerd. Derm is chock full of immunology - probably second to A&A.

So, go set up a derm rotation and see what you think of it.

 

[howelljolly]

Its more satisfying for me to see a 23 year old with asthma be able to breath again after she asks me to intubate her, because she's too tired to breath on her own... than it is for me to help her feel sexy again after taking away her acne.

but thats just me

 

[Pure Anergy]

Its more satisfying for me to see a 23 year old with asthma be able to breath again after she asks me to intubate her, because she's too tired to breath on her own... than it is for me to help her feel sexy again after taking away her acne.

but thats just me

He said psoriasis, not acne. I don't know, every dermatologist I've ever met seemed ridiculously happy like Substance said. Even doctors in other specialties seem almost reverent sometimes when they talk about how great derm is. I had kind of written it off though because it's so competitive. Thanks for the suggestion though, Substance. I'll think about it. I'm just not sure I'd be willing to move to South Dakota or something so I could be a dermatologist. (No offense intended to anyone from South Dakota 😳)

 

[dragonfly99]

I don't agree that treating derm diseases is more intellectually stimulating than treating COPD and HTN and "old people diseases". I also don't think that NP's are a good substitute for a doc in taking care of old, sick people with a lot of comorbidities. And many private practice dermatologists are working with NP's and PA's as well, so I don't think that primary care practice is "NP territory" while derm is not. I think any office-based specialty is potentially "NP territory". And that's probably OK as long as they (like any other person) know the limits of their knowledge and know when/if to ask for help and have access to it. Only a few specialties like radiology or surgery are not going to be "NP territory" before long, but there is such a shortage of health care workers that I don't think we have to worry about being eliminated any time soon (well maybe anesthesiology has to worry a LITTLE...but not much).

Of course the derm docs think they are smarter than the IM and most other folks, but not sure I agree with that (at least at some of the more academic hospitals). They were definitely the "nerds" with perfect GPA's in med school, though. And I do agree that derm has a cush lifestyle...that's why you see other docs acting jealous of the derms. If you like a cush lifestyle and you have an IM-type personality and you have the grades, derm might be a good fit for you, but be aware that it has one of the lowest, if not the lowest, match rate of any specialty. It's hard to match without doing derm research and being AOA and have 230+ on all your boards.

 

[BobA]

I think Derm and Optho do sound like good fits for you. As you've said, they're very competitive.

What about psych? Psychiatry is the only specialty where you are paid to spend time with your patients.

I've finally chosen psych because of the patient contact, and just because it's what I find most interesting.

I do miss the idea of "doing something" with my hands. But after all it is a job and nothing will be perfect. And there's always ECT, TMS or sleep medicine if you're so inclined.

Psych will afford me a lifestyle where I will be able to "so something" with my hands outside of work: build boats, guitars, garden, raise goats, whatever - because I won't be working more than I want to.

Edit to say - it will also afford me a lifestyle where I can do the "hands on work" of being a husband and father someday!

 

[Doctor Bagel]

Hey, I'm kinda there with you, op, because I came into medical school and into 3rd year thinking I wanted to do either psych or IM (probably with an eventual fellowship). Well, I'm 2 weeks into my IM rotation and hating it (admittedly I have a dysfunctional team, which doesn't help), but I feel like there's too much rounding and paperwork and too little actual patient contact. I know that actual IM practice is different, but I really don't know if I want to bother going through an IM residency. I also have a feeling I would hate ICU work, and I know that's something the residents have to do a lot, and I get like zero excitement about of performing a physical exam.

I love derm, have a competitive step 1 score and grades but no research. I have a feeling that I'd have to do a research year to make derm a possibility, and I'm not ready to do that. So anyway, glad to know I'm not the only one sitting there not liking what I thought I'd like.

 

[Pure Anergy]

I've thought some more about this and I don't want to apply to any specialty that I'm significantly below average for. I've seen what my friends who are graduating this year and applying to fields like ortho and ophtho are going through, and they are so stressed. It's not worth it to me to have to apply to 40 or 50 programs and then go wherever I can get in, if I get in at all. I was looking at the match outcomes from 2007 and I think plastics, derm, and ENT are out of my reach because of my Step 1 score. I am in the range or above the range for everything else. Rad onc would be a long shot because they want so much research. Did you know that over 20% of them have PhD? That's ridiculous! Props to people who are willing to do whatever it takes to be a dermatologist or a rad oncologist or whatever, but the truth is that I'm not willing to do derm research next year or go get a PhD in physics just so I can try to make up for having a slightly below average Step 1 score and get into derm or rad onc.

Doctor Bagel, I saw your posts in the clinical forum. I'm sorry you're having such a bad time. It sounds like your IM is way worse than mine was, so I will shut up, count my blessings, and stop complaining now. 😳

 

[dragonfly99]

drbagel,
don't be too quick to write off IM just because your team is malignant.
It's common when you are a med student to just start liking whatever specialty has the nicest residents, or maybe nicest attending, but really you need to try and pick what you would be happy doing for life, which is hard and requires more introspection.

But yes, there is a lot of paperwork in internal med...that's true of a lot of other specialties too, though. Ever watch a surgery intern dictating a pile of discharge summaries?