How will I know which specialty is right for me?

[creamfreesh]

I'm about 5 months into my third year, and was talking to my IM attending today about what specialty I am interested in. She mentioned that "you will know which one is right...every student does." And then I thought to myself, gee that sounds awfully nice, but is that really true for most people? I'm curious to hear about everyone's experience in determining their specialty. Was it very clear for you, or more of a ambiguous (or perhaps even default )type of decision? And what about all of the specialties one usually isn't automatically exposed to in medical school without making an independent effort - things like radiology, pathology, rad onc, plastic surgery, dermatology, etc? How is one supposed to know if they like those things if they don't even get experience with them? May there be some specialty I would love if I only got to know more about it, because right now, all I have done is ruled out ObGyn.

I am a little concerned because nothing at this point seems to be grabbing me. I'm curious: what reasons do you think deems a specialty worthy of consideration/rejection? What things are superficial and easily disregarded vs. significant? What is one to do if they finish 4th year with no real passion or predilection for any particular specialty?

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[ProfMD]

First two questions to answer for yourself:
1) Do you want direct patient contact? If no - look at radiology and pathology.
2) Are you interested in something more surgical or more medical?

Answering these two questions will help narrow the field markedly. The most important thing, though, it to be honest with yourself and choose a specialty you like, not one that would please you family, spouse, friends, etc.

 

[Psai]

More like you will know which one is wrong

 

[sloop]

I kind of knew what I wanted to do coming into med school anyway, but I kept an open mind throughout third year and here was my experience.

There will be rotations on which you are miserable. I hated IM with a passion (IM rounds are literally the worst), and would literally rather do almost anything else. I'd honestly rather be a surgical intern than a resident in IM. In retrospect the hours weren't even close to as bad as some other rotations but I was 10x more miserable. I would stand in the shower every morning thinking "what the **** am I doing with my life?" Obviously don't consider a specialty you hate.

There may be rotations where despite generally alright hours, you can't for the life of you seem to muster much of an interest in. For me this was pediatrics and family med. I found both insufferably filled with tons of ordinary illnesses and a general lack of urgency. I didn't find the rare stuff to be that interesting either. In any case, I wasn't really miserable on these rotations (mostly because the hours were nice and it saved them), but I wasn't really happy either. If you find that you hate the content of a rotation, don't go into it just because the hours are nice. That's a bonus, but you'll regret it if you don't like the content or find it interesting.

There may be rotations where you're tired as hell, but generally happy. For me, this was OB-GYN and most of Surgery. My hours were way longer than IM, but I was generally interested. I was happy to be doing stuff and involved in the whole process. You should consider these specialties if you're happy doing the work and you find the lifestyle acceptable. If you find something you like as much with a better lifestyle, though, I'd go with that other thing.

Then for me there was psych. The hours were pretty good and I found it all fascinating. It didn't really feel like work to read about patients or go home and study for the shelf. I enjoyed writing the consults and writing notes in charts. I liked the process of a mental status exam. I liked trying to figure out why someone is having mental status change. I liked seeing an acutely psychotic patient and having the primary team implore you to do something substantive now because a distruptive psychotic patient on the floors cannot really wait till tomorrow. I just loved it and fell in love with it.


If you don't fall in love, just do something you like that has a life style you find acceptable considering the work you're doing. It's not rocket science. For me, if I had hated psych, I probably would have done Gen Surg->Trauma.

 

[IslandStyle808]

What about those who choose a field that wasn't a required rotation? Were there also those of you who choose their field without even doing a 3rd year elective rotation? In both cases, how does one go about choosing during or before 3rd year?

 

[sloop]

What about those who choose a field that wasn't a required rotation? Were there also those of you who choose their field without even doing a 3rd year elective rotation? In both cases, how does one go about choosing during or before 3rd year?

I knew I wanted to do psych when I was in high school. I'd had experiences in volunteer activities and just on the street where I'd met people who were clearly mentally ill and I wanted to help them. I loved AP psychology in high school, but I also loved biology. I knew I couldn't be a lab rat. I thought medicine seemed like a super interesting and intellectually stimulating field that suited my personality and my aptitudes.

In college, doing philosophy coursework made me realize that I loved this type of thinking. I realized that, historically, psychiatry is one of the most philosophically oriented/open fields there is—certainly the most philosophically open medical specialty. I took a psychopharmacology class, which I loved. I was further exposed to the social consciousness and philosophical issues that make real differences in approaching patients (Is mental illness a personal characteristic? Is one's acceptance of treatment of mental illness a betrayal of their own identity and if so, to what extent? Is pharmacological enhancement immoral, and if so, does formal diagnosis mitigate this at all? Is there an ontological basis for our classification of mental illness and if so, what is it? Etc.)

In med school, I just realized that the more closely related something was to psychiatry, the more inherently interested I tended to be. Even stuff like endocrine problems were more interesting to me than things like musculoskeletal disease because I found myself thinking more extensively about how it could interact with thought and cognition.

Maybe I'm a special case though?

 

[ACSurgeon]

I'm about 5 months into my third year, and was talking to my IM attending today about what specialty I am interested in. She mentioned that "you will know which one is right...every student does." And then I thought to myself, gee that sounds awfully nice, but is that really true for most people? I'm curious to hear about everyone's experience in determining their specialty. Was it very clear for you, or more of a ambiguous (or perhaps even default )type of decision? And what about all of the specialties one usually isn't automatically exposed to in medical school without making an independent effort - things like radiology, pathology, rad onc, plastic surgery, dermatology, etc? How is one supposed to know if they like those things if they don't even get experience with them? May there be some specialty I would love if I only got to know more about it, because right now, all I have done is ruled out ObGyn.

I am a little concerned because nothing at this point seems to be grabbing me. I'm curious: what reasons do you think deems a specialty worthy of consideration/rejection? What things are superficial and easily disregarded vs. significant? What is one to do if they finish 4th year with no real passion or predilection for any particular specialty?

Finding the "right specialty" is like finding your "soulmate." It's a hoax. It's different for everyone. There are many specialties that you could do and be happy. You won't just stumble upon it and just click. That's not how it works.

First: try to decide what you might like by brainstorming. Somethings to consider: medical vs. surgical. Within medical specialties, procedural vs. not procedural. Patient population (young/old, sick/not sick, elective/urgent), disease(s) that interest you (i.e. organ system). Think of lifestyle. Think clinic vs. inpatient.

Second: try to do an elective or two in the couple of fields that might interest you.

Third: talk to as many people as possible (i.e. upper classmen and residents)

Fourth: pick something that excites you realizing that NOTHING is perfect. Avoid second guessing yourself and wondering what could have been. The reality is, you won't ever really know how much more you would have enjoyed something or how happy/unhappy you would have been if you could go back in time and pick differently.

Whatever you do, don't just cruz through 3rd year passively expecting to "be grabbed" by a specialty.

As you go through residency, your perspective evolves. This could make you happier or less happy with your decision. There's no fool proof method here.

If you're not sure that you love a specialty that is very demanding, do NOT do it or you'll be miserable as a resident. I've seen many happy anesthesia residents (pick other specialty with reasonable work-life balance in training) who don't love what they do, but don't mind it because they can still have a life now and can expect a nice life/paycheck in the near future.

 

[ACSurgeon]

What about those who choose a field that wasn't a required rotation? Were there also those of you who choose their field without even doing a 3rd year elective rotation? In both cases, how does one go about choosing during or before 3rd year?

You need the foresight to plan ahead. Get involved in research. Shadow a few people. Set up an elective or two.

Ultimately, there's a huge leap of faith involved. I flirted with ortho and urology. Had research in one, and empirically thought I'd be interested in the other. Did both as a third year and decided to do general surgery instead. No regrets.

 

[sloop]

Somethings to consider: medical vs. surgical.

This is kind of a specific point, but I would even say medical vs surgical vs psychiatric.

I think most people lump psych under "medical" but it's just too different to do so in my opinion. Besides the people who hate psych know pretty quickly so it becomes sort of moot. I hated IM with a burning passion and thought Family and Peds sucked almost as much with the exception of the hours. I loved Surgery and being in the OR, loved OB/GYN. If I had nixed psych because it was "medical" I think I'd be less happy. I've also met a lot of psych residents who loath medicine and a surprising number who enjoyed surgery.

Sometimes when I sit down and think about it, psych is set up more like a surgical field than a medical one when you look a little deeper. Psych rounds are usually relatively painless, but like surgical rounds, are largely made painful by some sort of dispo bull**** the social worker should have handled. You get to spend a bunch of your time (as an upper-level at least), doing interventions and getting highly skilled at doing them (and which often have multiple ways they can be done, but your method gets influenced a lot by your environment and who teaches you). You wind up consulted for a lot of **** that in theory every doctor should be able to do but has become your field's "thing."

 

[Spikebd]

This is kind of a specific point, but I would even say medical vs surgical vs psychiatric.

I think most people lump psych under "medical" but it's just too different to do so in my opinion. Besides the people who hate psych know pretty quickly so it becomes sort of moot. I hated IM with a burning passion and thought Family and Peds sucked almost as much with the exception of the hours. I loved Surgery and being in the OR, loved OB/GYN. If I had nixed psych because it was "medical" I think I'd be less happy. I've also met a lot of psych residents who loath medicine and a surprising number who enjoyed surgery.

Sometimes when I sit down and think about it, psych is set up more like a surgical field than a medical one when you look a little deeper. Psych rounds are usually relatively painless, but like surgical rounds, are largely made painful by some sort of dispo bull**** the social worker should have handled. You get to spend a bunch of your time (as an upper-level at least), doing interventions and getting highly skilled at doing them (and which often have multiple ways they can be done, but your method gets influenced a lot by your environment and who teaches you). You wind up consulted for a lot of **** that in theory every doctor should be able to do but has become your field's "thing."

You sound like me. I'm a fourth year about to go on surgical sub aways but keep flirting with the psych idea. Liberal arts background too. It's hard for me to give up the idea that since psych is so uncompetitive that I'd be wasting all that time and effort to get good scores for naught. I realize this is a bad mindset though. Something about psych draws me too though. How did you decide to make the leap for good?

 

[boshtrich]

In addition to these questions, I'd say consider whether you want a specialty that is predominantly outpatient vs predominantly inpatient. While most specialties have components of both, it's good to keep that in mind as both have their own pros and cons that can strongly influence your satisfaction. As several people have mentioned above, while predominantly outpatient specialties may tend to have better hours, that doesn't necessarily translate to more satisfaction due to the pace and acuity. Likewise, if you value a sense of predictability in your day, an outpatient setting would likely be a better choice than a call heavy inpatient specialty.

 

[sloop]

You sound like me. I'm a fourth year about to go on surgical sub aways but keep flirting with the psych idea. Liberal arts background too. It's hard for me to give up the idea that since psych is so uncompetitive that I'd be wasting all that time and effort to get good scores for naught. I realize this is a bad mindset though. Something about psych draws me too though. How did you decide to make the leap for good?

I did well on step 1 (>250), but I don't think it's a waste. I've been encouraged by everyone I talk to to apply to the most competitive residencies in the country. The top psych residencies are competitive and I think it was all time well-spent.

In terms of how I made the leap for good, I don't know. I take a lot of pride in dealing with the "difficult" patients that other fields can't handle or hate dealing with. I also just think that surgeons often (there are exceptions) suck at dealing with their patients as whole human beings. Something I literally saw on my surgery rotation (I kid you not): "[in reference to youngish patient POD1 s/p BKA] He's always crying when I walk in there to see him, and his mom is always there with him. What a *****."

I also just think I like the field a tiny bit more and the lifestyle is like 1000x better.

 

[dadaddadaBATMAN]

I'm about 5 months into my third year, and was talking to my IM attending today about what specialty I am interested in. She mentioned that "you will know which one is right...every student does." And then I thought to myself, gee that sounds awfully nice, but is that really true for most people? I'm curious to hear about everyone's experience in determining their specialty. Was it very clear for you, or more of a ambiguous (or perhaps even default )type of decision? And what about all of the specialties one usually isn't automatically exposed to in medical school without making an independent effort - things like radiology, pathology, rad onc, plastic surgery, dermatology, etc? How is one supposed to know if they like those things if they don't even get experience with them? May there be some specialty I would love if I only got to know more about it, because right now, all I have done is ruled out ObGyn.

I am a little concerned because nothing at this point seems to be grabbing me. I'm curious: what reasons do you think deems a specialty worthy of consideration/rejection? What things are superficial and easily disregarded vs. significant? What is one to do if they finish 4th year with no real passion or predilection for any particular specialty?

For some people it never clicks, for some people it reaches out and bites you in the ass. I didn't feel like I belonged anywhere, and I was super unhappy. Was planning to go into one of the specialties I tolerated.

I had considered EM early, but only did the rotation to rule out the specialty. For me, I was head over heels in love immediately. Mostly the pace, the acuity, the variety. It was seriously night and day obvious to me, and it was the only rotation I looked forward to going back to the hospital.

It's made my life dramatically better, because all of a sudden I have a purpose again. So I feel for your frustration, it sucks. Hang in there, watch for something you tolerate, hope for something you love.

 

[Tenk]

Figure out what your goals in life are by answering the following:

Do you want a pager?

Do you want to work in a clinic or the hospital?

Do you want to work for yourself or someone else?

How much time off do you want?

Do you want to see patients at all?

Do you love to operate?

How much money do you want to make and what kind of lifestyle do you want to live?

Answer these questions and then find the specialty that pisses you off the least and enjoy your LIFE.

Remember, this is a job, not a soulmate or some other bogus crap. I like my work but I like my days off a lot, lot more.

 

[CaffeinatedSquirrel]

I kind of knew what I wanted to do coming into med school anyway, but I kept an open mind throughout third year and here was my experience.

There will be rotations on which you are miserable. I hated IM with a passion (IM rounds are literally the worst), and would literally rather do almost anything else. I'd honestly rather be a surgical intern than a resident in IM. In retrospect the hours weren't even close to as bad as some other rotations but I was 10x more miserable. I would stand in the shower every morning thinking "what the **** am I doing with my life?" Obviously don't consider a specialty you hate.

There may be rotations where despite generally alright hours, you can't for the life of you seem to muster much of an interest in. For me this was pediatrics and family med. I found both insufferably filled with tons of ordinary illnesses and a general lack of urgency. I didn't find the rare stuff to be that interesting either. In any case, I wasn't really miserable on these rotations (mostly because the hours were nice and it saved them), but I wasn't really happy either. If you find that you hate the content of a rotation, don't go into it just because the hours are nice. That's a bonus, but you'll regret it if you don't like the content or find it interesting.

There may be rotations where you're tired as hell, but generally happy. For me, this was OB-GYN and most of Surgery. My hours were way longer than IM, but I was generally interested. I was happy to be doing stuff and involved in the whole process. You should consider these specialties if you're happy doing the work and you find the lifestyle acceptable. If you find something you like as much with a better lifestyle, though, I'd go with that other thing.

Then for me there was psych. The hours were pretty good and I found it all fascinating. It didn't really feel like work to read about patients or go home and study for the shelf. I enjoyed writing the consults and writing notes in charts. I liked the process of a mental status exam. I liked trying to figure out why someone is having mental status change. I liked seeing an acutely psychotic patient and having the primary team implore you to do something substantive now because a distruptive psychotic patient on the floors cannot really wait till tomorrow. I just loved it and fell in love with it.


If you don't fall in love, just do something you like that has a life style you find acceptable considering the work you're doing. It's not rocket science. For me, if I had hated psych, I probably would have done Gen Surg->Trauma.

@sloop, thanks for your helpful post(s)! This one will be featured in this week's SDN Newsletter, and I'll PM you with a code for an Amazon gift card. Thanks for being a positive contributor to the SDN community!

 

[Law2Doc]

1. While in med school you will have a few electives other than the core rotations, use them wisely. 2. Additionally, although it's not done enough, opportunities to shadow in your "spare time" exist in the first couple of years so you can see other fields. 3. You also can observe certain specialties while on other specialties. Eg If your patient gets sent down to IR to get a TIPS or to GI to get a colonoscopy, go with the patient.

 

[NWwildcat2013]

You need the foresight to plan ahead. Get involved in research. Shadow a few people. Set up an elective or two.

Ultimately, there's a huge leap of faith involved. I flirted with ortho and urology. Had research in one, and empirically thought I'd be interested in the other. Did both as a third year and decided to do general surgery instead. No regrets.

Starting to understand this. I think I may have an interest in ortho and I need to start doing some research whether it is what I end up doing or not. Just based on where I am in the timeline I need to start to prepare for something and if I fall short or change my mind then the research/hard work I put into one specialty will still pay off if I switch to another.

 

[Penn-mdphd]

I hated IM with a passion (IM rounds are literally the worst), and would literally rather do almost anything else. I'd honestly rather be a surgical intern than a resident in IM.

Dang, what made IM so bad to you? lol

 

[Psai]

Dang, what made IM so bad to you? lol

people who sit in the hospital who don't need to be in the hospital. lots of nursing home people looking for placement, people who probably can't be helped with their chronic issues that were admitted, tons of bs paperwork that helps nobody except lawyers and administrators.

Basically, gomers + a ****ty system

 

[TheFutureFatMan]

You'll see something like this, typically accompanied by trumpeting angels.

 

[sloop]

Dang, what made IM so bad to you? lol

The short answer? Because IM is terrible.

I mean, I know I'm harsh on it and there are some people for whom that's their thing. For me, I have a hard time thinking of something I'd enjoy less.

It's endless paperwork and charting (way more than any other specialty I've seen, for some reason). It's all about managing everybody's 18 chronic conditions so that they don't stroke out or decompensate in the hospital while you try to fix whatever 1 or 2 acute things are going wrong. About a third of your patients are dying quickly, a third are dying slowly and a lot of the remaining third are trying to kill themselves with their own stubbornness or stupidity ("No, I don't want to take heparin—it hurts!" said the nephrotic patient).

It's like managing a virtual aquarium where you log on, make sure the fish are being fed, make sure the pH and salinity of the water is just right, call people to make sure the filters are being changed and the pumps are working, log off at the end of the day and hope that as few fish as possible are floating on top when you come in the next morning.

 

[TheFutureFatMan]

Couldn't imagine being a flea for a living. One of my parents is one. That was enough to dissuade me from IM.


Sent from my iPhone using SDN mobile

 

[Amygdarya]

It's like managing a virtual aquarium where you log on, make sure the fish are being fed, make sure the pH and salinity of the water is just right, call people to make sure the filters are being changed and the pumps are working, log off at the end of the day and hope that as few fish as possible are floating on top when you come in the next morning.

Wow, this is a perfect description of hospitalist medicine.

 

[zeppelinpage4]

The short answer? Because IM is terrible.

I mean, I know I'm harsh on it and there are some people for whom that's their thing. For me, I have a hard time thinking of something I'd enjoy less.

It's endless paperwork and charting (way more than any other specialty I've seen, for some reason). It's all about managing everybody's 18 chronic conditions so that they don't stroke out or decompensate in the hospital while you try to fix whatever 1 or 2 acute things are going wrong. About a third of your patients are dying quickly, a third are dying slowly and a lot of the remaining third are trying to kill themselves with their own stubbornness or stupidity ("No, I don't want to take heparin—it hurts!" said the nephrotic patient).

It's like managing a virtual aquarium where you log on, make sure the fish are being fed, make sure the pH and salinity of the water is just right, call people to make sure the filters are being changed and the pumps are working, log off at the end of the day and hope that as few fish as possible are floating on top when you come in the next morning.

Your post literally made me lol. I felt the same about IM.
Posts like these are the reason why I read SDN. xD

 

[StraightOuttaBrooklyn]

The short answer? Because IM is terrible.

I mean, I know I'm harsh on it and there are some people for whom that's their thing. For me, I have a hard time thinking of something I'd enjoy less.

It's endless paperwork and charting (way more than any other specialty I've seen, for some reason). It's all about managing everybody's 18 chronic conditions so that they don't stroke out or decompensate in the hospital while you try to fix whatever 1 or 2 acute things are going wrong. About a third of your patients are dying quickly, a third are dying slowly and a lot of the remaining third are trying to kill themselves with their own stubbornness or stupidity ("No, I don't want to take heparin—it hurts!" said the nephrotic patient).

It's like managing a virtual aquarium where you log on, make sure the fish are being fed, make sure the pH and salinity of the water is just right, call people to make sure the filters are being changed and the pumps are working, log off at the end of the day and hope that as few fish as possible are floating on top when you come in the next morning.

Okay, so I love IM, but I also love the bolded. Spot-on.

 

[Kahreek]

The short answer? Because IM is terrible.

I mean, I know I'm harsh on it and there are some people for whom that's their thing. For me, I have a hard time thinking of something I'd enjoy less.

It's endless paperwork and charting (way more than any other specialty I've seen, for some reason). It's all about managing everybody's 18 chronic conditions so that they don't stroke out or decompensate in the hospital while you try to fix whatever 1 or 2 acute things are going wrong. About a third of your patients are dying quickly, a third are dying slowly and a lot of the remaining third are trying to kill themselves with their own stubbornness or stupidity ("No, I don't want to take heparin—it hurts!" said the nephrotic patient).

It's like managing a virtual aquarium where you log on, make sure the fish are being fed, make sure the pH and salinity of the water is just right, call people to make sure the filters are being changed and the pumps are working, log off at the end of the day and hope that as few fish as possible are floating on top when you come in the next morning.

exactly, I am glad to know I am not the only one to compare im with aquarium keeping.
In retrospect, i am the type of person who finds that having a fish tank is more fun than having a dog.

 

[W19]

SDN has become the site of IM bashing... Geez!

 

[akinetopsia]

While I think it is possible to "know it when you see it" I think most people have a general idea early on of what they do and don't like and it gets refined through clinical rotations. Examples: do you like medicine or surgery; do you like adults, kids, or both; and do you like inpatient or outpatient?

On the other hand, I've had some conversations with attendings where it goes typically like "X specialty (the one they practice) is the only one i liked" or "X specialty is the one where I looked around and liked the kind of people that are drawn to it." I guess the bottom line is that it's different for everyone - some people are dead set on a particular field, and other people whittle it down by what they don't like and it leaves a few viable options.