Is it all that bad? Trying to find a specialty...

[Jack is Back]

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After spending a tremendous amount of time and energy, I was able to get accepted to a few medical schools. All the various specialties looked great and I felt like a lot of options were in front of me. Being a proactive person, I've been trying to narrow down my specialty choices to about 3 by reading and talking with people in the field.

I was wondering if you could offer me advice based upon my interests. Also, I will list the specialties I thought would be great. After reading all these SDN threads though, it appears like there are so many problems in all these specialties. 🙁

Maybe I'm reading threads from pessimistic people?

Interest:

• Procedures
• Variety of work / variety of pathology
• Challenge, interesting work
• Being excellent or an expert
• Continuity of care (I don't mind if I have it or not)
• Limited research experience (I may like it, but don't want to study/research/study/research). May like to have a little free time in school.

I am trying to be debt free as soon as possible, but it is FAR more important to me to do something interesting. With need based aid and scholarships, my total medical school debt will only be $75,000 after 4 years. So a shorter residency is sometimes appealing because I am a non-traditional student (28+ yrs old).

I originally thought either Surgery, Anesthesiology, or Emergency Medicine would be a good fit. But there seems to be so many downsides to each of these fields.

General Surgery:
Turn ons: Procedures, immediate impact on helping someone, being an expert, variety of pathology and procedures, not overly competitive (like plastics/derm)
Turn offs: Taking over your entire life, no time for family or other things, tying you down to one place - lack of mobility, more difficult to do charity work due to less flexibility, increased liability / malpractice, could train 6-7 years after a fellowship (LONG residency)

Emergency:
Turn ons: Variety, no set schedule, good pay for time, time off, may allow for time serving in other countries, can move from city to city without seriously harming your income (flexibility), short 3 year residency, no pager/ no call, job market seems good and growing, maybe I could be an expert at emergency?
Turn offs: Shift work over night, people burning out because when they are off they are "zombies" due to circadian rhythm disruption, treating lots of primary care all day and few emergencies, being seen as a triage person instead of an actual expert, would this be selling out for shorter residency/quick income potential?, worried that the top selling point is how little hours you need to work (i.e. not being actually interesting)

Anesthesiology:
Turn ons: Seems like they have controlled schedules, the medicine seems pretty interesting (pharm + physio), variety of procedures and possible variety of cases to keep interest level up, may be more flexible to move from city to city
Turn offs: midlevel encroachment, could the anesthesia market crash in 10 years?, very reliant on politics, uncertain job market

Some of the surgical sub-specialties looked good, like ENT, but how do you know if you can get into such a competitive specialty. It seems like you would need to be gunning for that on day 1 of medical school.

I sometimes think, forget about lifestyle, just chose surgery. But then I realize, everyone find their job boring after 10 years, you might as well chose something that seems marginally interesting like EM and take the better schedule.

Are there any other specialties I should be looking at? What do you think would be the best choice based upon this post? Thanks in advance🙂

 

[nlax30]

I'd suggest not to worry too much about that decision until you're actually in medical school. Once you're in you can actually start getting some experience in the various fields and go from there.

You certainly don't need to come with a specific field in mind as most people change their minds at some point anyway. I'd say just keep an open mind and see what speaks to you once you start rotating around.

Every field is going to have its pros/cons and which will be different for different people.

 

[qmcat]

Every specialty has its downsides. Just do your best in med school and see which subjects/systems you enjoy the most and try to get exposure to different fields by shadowing if you have the spare time.

 

[shaggy alfresco]

Come back to this thread your 3rd year.

 

[MsKrispyKreme]

Come back to this thread your 3rd year.

Wait...he's just pre-med?

Dude, you should be memorizing Lippincott's Biochem and Robbins instead of worrying about specialties. You only have 2.5 months left, and your classmates have probably already started. Get a move on or it's Family Medicine for you, buddy.

 

[DrVanNostran]

OP you will realize what is true and what is not from your pros and cons once you start interacting more within the medical community. Even us as third and 4th year medical students are still very naive about the actual work environment and the future of medicine.

As a premed and medical student your focus should be on your education and life to not only broaden your knowledge base, but to make yourself a more well rounded individual.

 

[Law2Doc]

...
Some of the surgical sub-specialties looked good, like ENT, but how do you know if you can get into such a competitive specialty. It seems like you would need to be gunning for that on day 1 of medical school.
...

I don't disagree with the analysis you did on the three specialties you listed, but I think you are over-analyzing. Picking a specialty isn't about making lists, and weighing the positives versus the negatives. It's about finding something you enjoy and say, "gee I really like this and can totally see making this my career". You aren't going to come to that epiphany without direct exposure. Picking a specialty isn't something you can do on paper or based on the advice of an online bulletin board. So it behooves you to find a way to start getting exposure to as many fields as you can. Many you will get during your 3rd year core rotations (eg Gen surg). Others you can probably squeeze into the 1-2 electives you get in 4th year before you have to pull the trigger and apply. But others (maybe ENT, anesthesiology) you probably will get scant exposure to unless you push to get some. Which means that in second year, you may want to find time to "shadow" some of these fields to give yourself exposure. No way you can make this decision based on a pros/cons list. You make it based on working with residents and talking to them and seeing what they do. And keep your mind open -- many many med students come to med school thinking they are going to like some things and end up hating them, and think they are going to hate some things and end up loving them. About 90% of all med students change their minds at least once regarding a specialty. You simply don't know what fits until you try it on.

As for your above sentence, while I don't advocate "gunning" (that term has very negative connotations -- it's not someone who works hard and does well, it's someone who undermines others), I do think you owe it to yourself to do well and try to keep as many doors open for yourself until you actually do make a decision. So plan to hit the ground running and work hard as if you are shooting for derm. Then at the end of the race, if you decide you don't want derm, I promise the high grades/Step scores won't hurt you when you ultimately decide you want EM or whatever. But if you do decide that ENT was more to your liking, you will have that option, rather than kicking yourself as you "settle" for something else.

 

[Jack is Back]

Wait...he's just pre-med?

Dude, you should be memorizing Lippincott's Biochem and Robbins instead of worrying about specialties. You only have 2.5 months left, and your classmates have probably already started. Get a move on or it's Family Medicine for you, buddy.

tehe teheheh... so funny.

 

[Jack is Back]

I don't disagree with the analysis you did on the three specialties you listed, but I think you are over-analyzing. Picking a specialty isn't about making lists, and weighing the positives versus the negatives. It's about finding something you enjoy and say, "gee I really like this and can totally see making this my career". You aren't going to come to that epiphany without direct exposure. Picking a specialty isn't something you can do on paper or based on the advice of an online bulletin board. So it behooves you to find a way to start getting exposure to as many fields as you can. Many you will get during your 3rd year core rotations (eg Gen surg). Others you can probably squeeze into the 1-2 electives you get in 4th year before you have to pull the trigger and apply. But others (maybe ENT, anesthesiology) you probably will get scant exposure to unless you push to get some. Which means that in second year, you may want to find time to "shadow" some of these fields to give yourself exposure. No way you can make this decision based on a pros/cons list. You make it based on working with residents and talking to them and seeing what they do. And keep your mind open -- many many med students come to med school thinking they are going to like some things and end up hating them, and think they are going to hate some things and end up loving them. About 90% of all med students change their minds at least once regarding a specialty. You simply don't know what fits until you try it on.

As for your above sentence, while I don't advocate "gunning" (that term has very negative connotations -- it's not someone who works hard and does well, it's someone who undermines others), I do think you owe it to yourself to do well and try to keep as many doors open for yourself until you actually do make a decision. So plan to hit the ground running and work hard as if you are shooting for derm. Then at the end of the race, if you decide you don't want derm, I promise the high grades/Step scores won't hurt you when you ultimately decide you want EM or whatever. But if you do decide that ENT was more to your liking, you will have that option, rather than kicking yourself as you "settle" for something else.

Thanks for the advice. I guess I was just thinking about building my CV during M1 summer. I was trying to read through Isersons and they recommend finding an advisor in your first year, so I was trying to find an advisor in the field I wanted to match.

My end goal is to gain an excellent residency at a big name hospital. I have very little on my resume as I am a non-trad (pre-reqs/mcat/application/volunteering took all my time), so I was trying to have a focus so that I could begin to put things on my CV early. If I do surgery research will that help as EM or Anesthesia? Or for example, ENT, if I did Anesthesia or EM research, they wouldn't care at all for ENT, correct? That's what I've heard.

 

[muhali3]

Thanks for the advice. I guess I was just thinking about building my CV during M1 summer. I was trying to read through Isersons and they recommend finding an advisor in your first year, so I was trying to find an advisor in the field I wanted to match.

My end goal is to gain an excellent residency at a big name hospital. I have very little on my resume as I am a non-trad (pre-reqs/mcat/application/volunteering took all my time), so I was trying to have a focus so that I could begin to put things on my CV early. If I do surgery research will that help as EM or Anesthesia? Or for example, ENT, if I did Anesthesia or EM research, they wouldn't care at all for ENT, correct? That's what I've heard.

I'll answer your questions, despite having no actual experience...

EM and Anesthesia are not very research heavy, and they are easy to match into with little if any research. But if you're trying to match into a big name program, a good amount of research is near essential.

If you did research in another specialty that does not apply to the specialty you're applying for, that research will not boost your application as much (obviously), but it would still be a boost to your application, however small. If you've narrowed down your specialty choices to 2 or 3, you could do research that overlaps with all those fields, so you don't have to feel as restricted in what research opportunities to pursue.

 

[lrkoehle]

If I do surgery research will that help as EM or Anesthesia? Or for example, ENT, if I did Anesthesia or EM research, they wouldn't care at all for ENT, correct? That's what I've heard.

Obviously, it's better to do research in the field you end up going into. I wouldn't go so far as to say they don't care about research in other fields though. They know lots (most?) people end up changing specialty choice at some point, so not everyone will have 5-10 research experiences in a their final choice. However, the more competitive the specialty the more important it will be to have research in that field (e.g. you'll need neuro research for a neurosurg residency).

As others have said, focus on getting exposure in first year (join interest group clubs, scrub in on surgeries, etc.). Doing research after MS-I is another great way to gain exposure to a field too. It might be good to take the most competitive thing you might be interested in and do research in that so if you go for it you'll be better off.

 

[Law2Doc]

...
My end goal is to gain an excellent residency at a big name hospital. ...

These don't always overlap, and your premed-ness is showing through here. In some specialties, many of the very solid residencies are not at "big name hospitals" and in other specialties a big name hospital's program can be outright malignant as compared to something with less of a national name but a good local reputation. (Several gen surg places come to mind). Which places are "better/worse" are very much a word of mouth thing, and based more on the personalities of the higher ups (beneficent chairmen, PDs) and the culture than on the name on the hospital door. I would modify your goal to be to simply match into a "solid residency for the specialty" you ultimately choose, and leave it at that. Honestly, if you end up choosing a specialty without a need for fellowship, you are not necessarily going to be well served by a big academic name focused on research and academic medicine as much as a non-malignant place that gets you a lot of hands on training.

What you need to do, as I suggested above, is start shadowing in various potentially interesting specialties in your spare time in the pre-clinical years. Then keep an open mind for the core rotations your third year. Once you find something that you find really intriguing as a potential career, snag a faculty member to be your mentor. S/he will get the word on the street for you regarding what places are benign versus malignant, which places are up-and-comers, and which ones are on the decline. And then in 4th year you apply, interview, and talk to lots of current residents.

But all this is in the distant future for you. Don't worry about picking a specialty at this juncture. Don't worry about doing research that may be a bit off target. All research looks good on a CV, and you can always do specialty specific stuff later, if need be. Worry about getting exposed to enough specialties to actually make the decision. And getting good enough grades/Step I scores to actually have a choice amongst multiple fields. The actual choice of mentors and as to which residency is the goal are decisions you shouldn't be making until much later, after you pick a specialty.

 

[Jack is Back]

Thanks for the reply. I will just work hard my first 2 years, do as well as I can on Step 1, and shadow as many of the interesting fields I can.

I was deadset on finding my specialty before school but it appears to be too difficult and I don't have enough informationt to make the decision.

In response to the "pre-med'ness" comment, it is my goal to go work in a big city at a very good hospital. It's just a career aspiration and I understand that top hospital doesn't mean top residency program. It's still a goal of mine.

Thanks for everyone's help and wisdom. I'll be focused on my basic sciences for now.

 

[Law2Doc]

T...
In response to the "pre-med'ness" comment, it is my goal to go work in a big city at a very good hospital. It's just a career aspiration and I understand that top hospital doesn't mean top residency program. It's still a goal of mine.....

You will refine this as you get further along, and start realizing what factors matter, and what don't. It will sound very premed to you as well when you look back in a few years. Don't get hung up on these kinds of "goals" at this stage -- some things are going to matter to you more than other things in a few years.

 

[OveractiveBrain]

You will refine this as you get further along, and start realizing what factors matter, and what don't. It will sound very premed to you as well when you look back in a few years. Don't get hung up on these kinds of "goals" at this stage -- some things are going to matter to you more than other things in a few years.

I'm pretty sure he's feeling the pressure people insinuate about Derm or Neurosurgery, where the wackadoos applying start research in the second semester of first year.

Im just going to give you the same advice. Calm it down. E'ery ting gone be awright.

 

[Tapepsi]

I have some ideas about what I want to do as well, but since we're only premeds and haven't actually started school, as the med students have already said it's better if we wait until our clinical rotations before deciding.

If there was some type of research you were interested in pursuing, have it cover a broader topic rather than a specific one (if that's possible) so that you don't have to explain to a residency director why you chose to research x when you're applying to a program that has nothing to do with it.