MD Incoming M1 here. Should I start med school with a specialty in mind?

[456432]

Seems like everyone I know who has been accepted this cycle has a specialty in mind. When people ask me, however, I always feel stupid with my response: "I'm not sure." I've shadowed a multitude of MD's in a variety of fields, but nothing specific has truly clicked.

I understand that it's quite possible that I will find my passion during rotations as an M3, but would it be highly advantageous to try and focus on one specialty as early as M1 year (particularly when it comes to research in that field), especially if I want to go into something as competitive as derm/ortho/plastics/gen surg/ophtho?

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[Matthew9Thirtyfive]

Not being sure is totally fine. And you’ll probably change your mind. I was really interested in pathology during my preclinical years and now I want to do surgery.

 

[DrRiker]

No, you don't need to have one in mind. But you should start thinking about it so that you can be smart about choosing electives in M3. Big questions like surgery or no surgery, peds or adults, etc.

Also, my general advice, aim for your most competitive interest early on. If you have even remote interest in something like plastics, do research and some extracurriculars related to that. It's easier to pivot to less competitive specialties than it is to more competitive specialties.

 

[Goro]

Seems like everyone I know who has been accepted this cycle has a specialty in mind. When people ask me, however, I always feel stupid with my response: "I'm not sure." I've shadowed a multitude of MD's in a variety of fields, but nothing specific has truly clicked.

I understand that it's quite possible that I will find my passion during rotations as an M3, but would it be highly advantageous to try and focus on one specialty as early as M1 year (particularly when it comes to research in that field), especially if I want to go into something as competitive as derm/ortho/plastics/gen surg/ophtho?

Nope,, because you'll be changing your mind.

 

[EmilKraepelin55]

Dude I thought I would go ENT or pathology before med school, then neurology/psychiatry after my preclinical neuroanatomy and psych coursework, FM for a hot minute on rotation, and now 100% going psych. Don’t sweat it too much. I definitely agree with working your coursework having the most competitive specialty you may be interested in on the mind, but don’t feel pressured to choose right now. Go with the flow, work hard, and see where you stand later on.

 

[aldol16]

It's good to have it in mind if it's a competitive specialty. That's because networking early and getting involved in research is key. It's always easier to start out with the most competitive one you have in mind and then change later than the other way around.

 

[Davidfromcali]

If you have a competitive specialty in mind, then getting started early helps. Actually knew a student who was pretty undecided on neurosurgery and neurology. She built an app for Nsurg in case she wanted to do that. Ended in neurology but still would of been in a good place to match Nsurg since she started so early. Maybe it just comes with a piece of mind

 

[Gilakend]

Convince yourself to love derm or ophtho

 

[Tenk]

It’s actually better (and easier) to eliminate specialties than focus on one or two. This will narrow down your choices. Then you can figure it out based on lifestyle, pay, and the actual job.

 

[mrbreakfast]

I have absolutely no evidence for this statistic but I've repeatedly heard ~80% of med students who start M1 with a field in mind end up picking something else. The percentage of the class that remains interested in surgery generally plummets once clerkships start.

As others said, the easiest solution is to eliminate specialties one by one. Another piece of advice I give to med students is find the clerkship you're the least bored in.

I also agree it's useful to treat your preclinical years like you're pursuing a competitive specialty. You can at least look into the competitive specialties (surgical subspecialties, ophtho, derm, and rad onc back when I was applying) in case something catches your eye. If you fall in love with ENT late in M3, for example, that's probably too late to put together a strong application.

 

[Avulse]

Seems like everyone I know who has been accepted this cycle has a specialty in mind. When people ask me, however, I always feel stupid with my response: "I'm not sure." I've shadowed a multitude of MD's in a variety of fields, but nothing specific has truly clicked.

I understand that it's quite possible that I will find my passion during rotations as an M3, but would it be highly advantageous to try and focus on one specialty as early as M1 year (particularly when it comes to research in that field), especially if I want to go into something as competitive as derm/ortho/plastics/gen surg/ophtho?

nah

 

[wamcp]

Seems like everyone I know who has been accepted this cycle has a specialty in mind. When people ask me, however, I always feel stupid with my response: "I'm not sure." I've shadowed a multitude of MD's in a variety of fields, but nothing specific has truly clicked.

I understand that it's quite possible that I will find my passion during rotations as an M3, but would it be highly advantageous to try and focus on one specialty as early as M1 year (particularly when it comes to research in that field), especially if I want to go into something as competitive as derm/ortho/plastics/gen surg/ophtho?

As an attending, I recommend keeping in mind which specialties to NOT ever consider in terms of terrible job market/pay. You will likely regret it and be miserable

for example, don’t do emergency med, radonc etc

 

[FindersFee5]

Not being sure is totally fine. And you’ll probably change your mind. I was really interested in pathology during my preclinical years and now I want to do surgery.

Really? I thought you the poster child for 'surgery is cool, but I would never want to be a surgeon.'

 

[Matthew9Thirtyfive]

Really? I thought you the poster child for 'surgery is cool, but I would never want to be a surgeon.'

Yeah, I was. But then I did my surgery rotation. Just absolutely loved it.

 

[PapaGuava]

I'd say keep an open mind for everything and just perform well your first two years so you don't close any doors before entering rotations. However, definitely take the time to look into different fields along the way and read about them.

 

[ThatSerb]

Not being sure is totally fine. And you’ll probably change your mind. I was really interested in pathology during my preclinical years and now I want to do surgery.

was pathology not as great for you as you thought it would be? or was surgery just too awesome

 

[Matthew9Thirtyfive]

was pathology not as great for you as you thought it would be? or was surgery just too awesome

Path is interesting, but I ended up really loving direct patient care. And surgery was just so cool. I literally loved every single day of my rotation and looked forward to going to work on Mondays.

 

[FindersFee5]

Yeah, I was. But then I did my surgery rotation. Just absolutely loved it.

That's really interesting, especially with your significant exposure to the OR prior to med school! What do you think was different about the rotation?

Thinking gen surg or a specialty?

 

[Matthew9Thirtyfive]

That's really interesting, especially with your significant exposure to the OR prior to med school! What do you think was different about the rotation?

Thinking gen surg or a specialty?

Yeah I actually thought I wouldn’t want to do surgery because I had been an OR tech and was kind of over it. I didn’t realize how much I missed the OR until I was back in it.

I also really loved the whole thing. I like rounding on our patients, but I like that rounds are short and to the point and that notes are straightforward and short. I enjoyed clinic, but I liked that clinic was only 2-3 days a week and was broken up with 2-3 days in the OR. Also, being involved in the total care of the patient and not just the small part in the OR made it much more interesting.

Also, I really love DOING stuff. I got to do a few small cases as primary, and it was like the coolest thing ever.

I assumed I would want to do a surgical sub. I enjoyed urology (we do 5 weeks of surgical sub, half one sub and half another—I did urology and ENT), but tbh I was actually really sad when my general surgery rotation was over, but I was okay moving on from the subs. So right now I’m thinking general surgery or a fellowship off that, possibly peds surgery (my fav part of uro and ENT was working with the kiddos).

 

[mwsapphire]

That's really interesting, especially with your significant exposure to the OR prior to med school! What do you think was different about the rotation?

Thinking gen surg or a specialty?

Aren't most gen surgeons " specialists" in some way? I feel like they all focus on a couple of procedures. ( Gen surg I scribed for did hemorrhoids and gall bladders, and used to do abd. wall reconstructions and breasts, but not appendectomies or colectomies for Crohinies, for example).

 

[mwsapphire]

Yeah I actually thought I wouldn’t want to do surgery because I had been an OR tech and was kind of over it. I didn’t realize how much I missed the OR until I was back in it.

I also really loved the whole thing. I like rounding on our patients, but I like that rounds are short and to the point and that notes are straightforward and short. I enjoyed clinic, but I liked that clinic was only 2-3 days a week and was broken up with 2-3 days in the OR. Also, being involved in the total care of the patient and not just the small part in the OR made it much more interesting.

Also, I really love DOING stuff. I got to do a few small cases as primary, and it was like the coolest thing ever.

I assumed I would want to do a surgical sub. I enjoyed urology (we do 5 weeks of surgical sub, half one sub and half another—I did urology and ENT), but tbh I was actually really sad when my general surgery rotation was over, but I was okay moving on from the subs. So right now I’m thinking general surgery or a fellowship off that, possibly peds surgery (my fav part of uro and ENT was working with the kiddos).

But w a family, isn't surgery residency a tough choice? ( and being a surgeon in general lol).

 

[FindersFee5]

Aren't most gen surgeons " specialists" in some way? I feel like they all focus on a couple of procedures. ( Gen surg I scribed for did hemorrhoids and gall bladders, and used to do abd. wall reconstructions and breasts, but not appendectomies or colectomies for Crohinies, for example).

In that context, I meant gen surg or a surgical specialty like ortho, ENT, plastics etc.

But w a family, isn't surgery residency a tough choice? ( and being a surgeon in general lol).

I'm starting surgical residency with a toddler next year. There are going to be sacrifices. During one of my sub-is, I didn't see my son for 13 days straight because I left before he woke up and came back after 8 every night. But it's doable with a strong support network and an understanding spouse. I also strongly believe that finding fulfillment at work has a positive trickle down effect on my parenting.

 

[Matthew9Thirtyfive]

Aren't most gen surgeons " specialists" in some way? I feel like they all focus on a couple of procedures. ( Gen surg I scribed for did hemorrhoids and gall bladders, and used to do abd. wall reconstructions and breasts, but not appendectomies or colectomies for Crohinies, for example).

Depends on where you are. The general surgeons I worked with on rotation did gallbags, appies, hernias, thyroids, breast, bariatrics, colectomies, etc. Not all of them did all of that, but most of them did most of it. But yeah, I think he meant more like gen surg vs ent/uro/etc

But w a family, isn't surgery residency a tough choice? ( and being a surgeon in general lol).

Some of the residents here are in their late 30s or early 40s. Some have kids. Residency is hard no matter what specialty you pick, but I think it’s overblown how difficult surgery is as an attending. The surgeons here have plenty of time for family. They’re out the door most days no later than 4-5 and have a pretty good call schedule. You can certainly work yourself silly if you want, but I’ve been told by multiple surgery attendings that it’s not hard to have a good balance.

 

[mwsapphire]

Depends on where you are. The general surgeons I worked with on rotation did gallbags, appies, hernias, thyroids, breast, bariatrics, colectomies, etc. Not all of them did all of that, but most of them did most of it. But yeah, I think he meant more like gen surg vs ent/uro/etc



Some of the residents here are in their late 30s or early 40s. Some have kids. Residency is hard no matter what specialty you pick, but I think it’s overblown how difficult surgery is as an attending. The surgeons here have plenty of time for family. They’re out the door most days no later than 4-5 and have a pretty good call schedule. You can certainly work yourself silly if you want, but I’ve been told by multiple surgery attendings that it’s not hard to have a good balance.

The guy I worked for did 60 hour weeks and would literally drink coffee when he got home so he could stay awake to do something other than work....but I guess to each their own. He also had admin and teaching duties.

 

[Matthew9Thirtyfive]

The guy I worked for did 60 hour weeks and would literally drink coffee when he got home so he could stay awake to do something other than work....but I guess to each their own. He also had admin and teaching duties.

I mean, 60 hour work weeks isn’t bad. 50-60 is pretty average for most specialties. If you’re working 6-4:30 5 days a week, that’s 55 hours. If you need to drink coffee at home after getting off before 5 o’clock, you might want to evaluate your sleep patterns. The surgeons here have academic and teaching duties too and came in after me and left before me usually. Definitely possible to have a life if you want it.

 

[mwsapphire]

I mean, 60 hour work weeks isn’t bad. 50-60 is pretty average for most specialties. If you’re working 6-4:30 5 days a week, that’s 55 hours. If you need to drink coffee at home after getting off before 5 o’clock, you might want to evaluate your sleep patterns. The surgeons here have academic and teaching duties too and came in after me and left before me usually. Definitely possible to have a life if you want it.

Most survey data puts most docs at 40-50, and most other outpatient docs/ EM docs/ hospitalists average 50 hours or less per week. Most non surgeons I've talked to do under 50 hours a week.

You gotta keep in mind, 10 hour/week makes a difference after the 50 hr mark. ( and after 60 hrs/week , ever couple of hours makes a difference, and after the 70 hours weeks, ever hour makes a difference). To each their own I'm just surprised to see a family oriented person wanting to do surgery I guess. Always sort of surprising to me.

 

[Matthew9Thirtyfive]

Most survey data puts most docs at 40-50, and most other outpatient docs/ EM docs/ hospitalists average 50 hours or less per week. Most non surgeons I've talked to do under 50 hours a week.

You gotta keep in mind, 10 hour/week makes a difference after the 50 hr mark. ( and after 60 hrs/week , ever couple of hours makes a difference, and after the 70 hours weeks, ever hour makes a difference). To each their own I'm just surprised to see a family oriented person wanting to do surgery I guess. Always sort of surprising to me.

Responded in the social thread to keep this one on topic.

 

[sloop]

I knew I wanted to do psychiatry since I applied to my combined BS/MD program in high school but, having gone through the whole process now, I can tell you that is definitely the exception rather than the rule.

Many people don’t know exactly what they want to do coming into med school. Many don’t even get a general sense of what they like until they start clinical rotations (though it can be advantageous to have an idea a bit before then). Even people who think they know what they want to do often change their minds (or boards come and go and they’re no longer as competitive as they envisioned). It’s all a process. As long as you know you want to be a doctor, you’re in the right place for now. I wouldn’t worry about it.

 

[Matthew9Thirtyfive]

I knew I wanted to do psychiatry since I applied to my combined BS/MD program in high school but, having gone through the whole process now, I can tell you that is definitely the exception rather than the rule.

Many people don’t know exactly what they want to do coming into med school. Many don’t even get a general sense of what they like until they start clinical rotations (though it can be advantageous to have an idea a bit before then). Even people who think they know what they want to do often change their minds (or boards come and go and they’re no longer as competitive as they envisioned). It’s all a process. As long as you know you want to be a doctor, you’re in the right place for now. I wouldn’t worry about it.

Yeah I think I saw a paper that looked at this, and like 74% of students ended up in a different field from what they initially thought starting med school.

 

[sloop]

Yeah I think I saw a paper that looked at this, and like 74% of students ended up in a different field from what they initially thought starting med school.

That seems about right.

Anecdotally, it seemed like more of the people I talked to on day 1 who said they were interested in psychiatry wound up in psychiatry than people interested in other specialties wound up in those (though a bunch of people who didn’t initially express interest in it also wound up in the field). I think part of that is just that psych is different enough to other fields that people who are really interested are less likely to be lured away by another field. I knew like 3 other people who told me they were interested in psych during orientation and all of them wound up matching psych.

 

[calivianya]

Definitely not critical to know, especially if you’re willing to work in a rural environment after.

One thing I have noticed at my very rural third year site is just how flexible physicians are in these areas. We have gen surg guys doing axillobifemoral bypass surgery and tons of vascular procedures because the hospital doesn’t have a vascular surgeon. They also do ENT and some uro because the coverage on those is spotty. We have family practice docs handling aesthetic/derm practices and doing everything from Fraxel/Pearl lasers to Botox to cyst removals to skin biopsies in addition to handling DM and HTN.

So, if you like derm, going into FM is fine if you want a rural practice because all the actual dermatologists are booked six months out because there’s only one in the whole dang region, so it‘s easy to have half or more of your practice be dermatology to meet that need. Some days with my FM preceptor were mostly derm. Same if you want to do vascular surgery because we have one gen surgeon who pretty much has decided he wants to do mostly vascular cases and so the gallbladders are rarer for him than the carotid endarterectomies.

But if you want to do things like derm or vascular in NYC, things are a little bit different.