Knowing what specialty to go into before vs. after medical school

[Adapt]

I hear a lot of talk about how students go into medical school believing almost for sure they will enter into a specific specialty, but once they do their rotations, change their minds and end up doing something else.

I was wondering if anyone out there actually went into medical school knowing they wanted to do only one specialty and actually ended up doing that. Is this fairly common or is this more the exception rather than the rule?

The reason I ask is that I am overly confident I want to be an FP and do not foresee myself changing my mind. Knowing how medical school is, does anyone think it's unlikely that I would still want to be an FP once through my rotations?

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[Seaglass]

I think it's actually something like a third of each: knowing want you want to do and sticking to it, not knowing at all and finding something you like, and changing your mind. I went in thinking I wanted to do EM, changed my mind a few times, but ultimately decided EM. Lots of my classmates knew what they wanted to do and are sticking to it, and lots of them had no idea until they had done their rotations. if your reasons for deciding to do FP are based on real experiences with FP and good information about FP lifestyles and reimbursement then you are more likely to stick to it.

Casey

 

[Adapt]

Originally posted by cg1155
I think it's actually something like a third of each: knowing want you want to do and sticking to it, not knowing at all and finding something you like, and changing your mind. I went in thinking I wanted to do EM, changed my mind a few times, but ultimately decided EM. Lots of my classmates knew what they wanted to do and are sticking to it, and lots of them had no idea until they had done their rotations. if your reasons for deciding to do FP are based on real experiences with FP and good information about FP lifestyles and reimbursement then you are more likely to stick to it.

Casey

I see. Thanks for the info. Anyone else have experiences like this?

 

[Jim Picotte]

I went into school wanting to do either FP or IM and finally decided on radiology. Some people stick with their first choice, others change and it's not common at all to do something that you didn't expect to do when you first started medical school.

 

[AJM]

Keep in mind that you have probably not been exposed to many specialties. The common theme that I have noticed is that when many people start med school, they are 100% sure they want to be a (fill in the blank) physician. Often their plans are based on having worked with physicians in that specialty. But their expected specialty choice is often the only specialty they have ever come into contact with before medical school, so they don't have anything to compare it to. Once these students start their clinical training, they discover what other specialties are like, and will often change their minds.

As an example, when I was an undergrad, I worked with a transplant surgeon. I fell in love with surgery, was absolutely sure I was going to be a surgeon, and even did research in surgery as a preclinical medical student. But, I had no exposure to any other field of medicine, so nothing to compare this specialty with. I didn't make my specialty choice change until near the end of my 3rd year (after I had seen what non-surgery careers were like). My roommate in med school was in a similar situation -- she was 100% sure that she was going to be an FP because of all the FP's she had worked with before med school. She was very involved in our school's primary care interest group, and arranged her clinical rotations around her interest in FP. Then she did her surgery rotation as a 3rd year, and everything changed -- she is now a general surgery resident and loving it.

Now, I'm not saying that you will definitely change your career choices, but you should by all means keep an open mind when you go to med school. There's a reason many people do change their minds in med school -- and it's often because they get exposure to many different specialties that they never thought that they would have considered, let alone liked.

To answer your initial question, there are people who know what they are going to do before med school and stick with it. If I were to estimate, out of those who were 100% sure of their expected specialty on starting med school in my class, maybe a quarter to a third ended up actually going into their planned specialty.

 

[AJM]

Originally posted by Jim Picotte
I went into school wanting to do either FP or IM and finally decided on radiology. Some people stick with their first choice, others change and it's not common at all to do something that you didn't expect to do when you first started medical school.

Did you mean it's not UNcommon to do something you didn't expect to initially do?

 

[Lonestar]

Went into med school thinking either FP or IM, now applying for Radiology.

 

[DOtobe]

I know that for me personally (although I am only an MS-III) that I started med school wanting to do pediatrics, but now that I am on rotations and have liked a few different things and will undoubtedly like more, I have no idea what I want to be when I grow up...

 

[Skrubz]

Came into med school "knowing" i wanted to do geriatrics...

Was set on neuro by my second year...

And now applying for anesthesia.

 

[Whisker Barrel Cortex]

Came in thinking primary care or neurology. Now doing Radiology.

 

[Adapt]

For the life of me, I will go into medical school thinking family practice, and I will come out an FP.

 

[pmichaelmd]

Greetings,
It is very common to change your mind about career direction in medicine while in med school. I too went through a plethora of career choices before settling. In undergrad I was certain I would be an orthopedic surgeon until I was able to witness a total hip on a 73-year old woman. That did away with my idea of the finesse of surgery. I also did research in nuke med/medical physics as an undergrad, but that didn't pan out. Started med school and thought about ENT, but realized how beastly any bit of general surgery residency was and that, on the whole, my personality did not fit in with the surgeon stereotype.

After much soul searching, I decided on FP. I spent much elective time doing primary care in NYC and was certain this was for me. I went ahead and did a family practice internship in the military and quickly found out that I didn't want to do that either. What I did like was the procedural aspect, but not the enforced 15-minute visits that ended with "..oh, by the way doctor, I have had blood pouring from my anus for 3 weeks. Is that normal?" Quite frustrating. Fortunately, as a military member, I was able to go and practice as a flight surgeon (general practitioner) after passing step III and reflect on career choices. I eventually decided on anesthesia and will start my CA-1 year this coming June.

Ain't life grand?

PMMD

 

[Winged Scapula]

I was sure I was going to be an Internist of some sort - really enjoyed Endocrine when I did research before medical school. This after I had planned a career in Psychology.

No one was more shocked than I when I decided on a surgical career. It is not uncommon at all to switch during medical school.

 

[Adapt]

It is interesting to see that most people who have responded have changed their speciality of interest many times while in medical school.

However, I intend on going in wanting to do FP and coming out an FP. In order to accomplish this, I will do several things. First, I will probably go DO over MD in order to limit my opportunities to specialize. Second, I will probably look into getting primary care loans which have a tough penalty if you choose not to enter into primary care.

Thus, my wish to enter into FP will be secure. Don't you just love it...

 

[Seaglass]

Umm, that reasoning seems a bit backwards to me. You will have to do this job for the rest of your life, so it's best to pick the one you really LIKE the best.

Casey

 

[rirriri]

Originally posted by Slickness
It is interesting to see that most people who have responded have changed their speciality of interest many times while in medical school.

However, I intend on going in wanting to do FP and coming out an FP. In order to accomplish this, I will do several things. First, I will probably go DO over MD in order to limit my opportunities to specialize. Second, I will probably look into getting primary care loans which have a tough penalty if you choose not to enter into primary care.

Thus, my wish to enter into FP will be secure. Don't you just love it...

errrrr, right. you might as well smash your head into the wall to ensure that you will die one day.

your logic is severely flawed.

 

[Adapt]

Originally posted by Dr. Cuts
Interesting. Perhaps you should consider a Caribbean school.

Not in a million years.

I don't know why people think my logic is flawed. I really do believe I will be an FP. Thus, I will take actions to make sure I am. Preventive measures if you will. That's all.

Perhaps I'll restate it. DO schools emphasize primary care which is what I want. OMM would be an added advantage that I could use as an FP. Primary care loans give lower interest rates so I will have to pay less back. All this because I know my goal is to be an FP.

Either way I word it, you get the picture.

 

[Voxel]

Always leave yourself with a way out.

You're really sure you want to do FP now, but how much do you know about the other fields in medicine? Have you shadowed all the specialties. I did a fair number of shadowing of non-core specialties. It really helped me make an informed decision between radiology and other fields I was considering.

When you walk into a room, make sure you know were the exits are and where they lead.

 

[rirriri]

i'm sorry slickness, but that's just dumb.

FP is one of the easiest residencies to get....it's not going anywhere, so i don't think you have to take precautions to make sure you can do it later.

Medicine is full of lots of different and interesting fields, most of which you probably don't know much about.

Limiting yourself is just stagnant and useless....it is best to keep everything open and set your goals and be confident. Pre-deciding things before knowing what else is out there is very naive.

cheers and all the best

PS. in addition to the Carribbean, if you *really* want an FP spot, you might as well throw your US Passport away and pretend as if you need an H1/J1 Visa.

 

[Flipchick]

I agree with the posts above. Slickness, don't throw away your opportunities now before you even get to see what's out there!

I was dead-set into going into pediatrics, and was also going to get a primary care loan during years 1 and 2, but decided otherwise so I can choose to do something non-primary care if I wanted to. I'm glad I did, because I'm now applying for EM residencies, which is not technically considered a primary care specialty.

 

[What the pho]

Originally posted by Slickness
Not in a million years.

I don't know why people think my logic is flawed. I really do believe I will be an FP. Thus, I will take actions to make sure I am. Preventive measures if you will. That's all.

Perhaps I'll restate it. DO schools emphasize primary care which is what I want. OMM would be an added advantage that I could use as an FP. Primary care loans give lower interest rates so I will have to pay less back. All this because I know my goal is to be an FP.

Either way I word it, you get the picture.

The picture is you have flawd logic. If you want primary care so bad why not just go PA or NP, that way you can limit your options even more.

Why even post the question if you already know the answer for sure? Do you remember how when you started college you thought you knew everything, and now look back and realize you didn't know jack. Trust me you'll have that same feeling again when you finish med school.

 

[Adapt]

Originally posted by What the pho
Why even post the question if you already know the answer for sure?

I started this thread because I wanted to see the odds of me actually changing my mind based on how many others did. I guess the odds are heavily stacked against me.

 

[jazz]

the people i know who didn't change their mind usually had a practice they were planning to take over -- i.e their parent's family practice.

i think until you rotate through the specialties, you won't know what you like. i entered med school knowing i wanted to be a doctor. thought IM for sure (i mean by pure stats -- highest number of people go into medicine) hated my medicine rotation.

dreaded the surgery rotation -- loved it! did a subI in surgery then elective in er. applied for and matched in er. that, after telling a friend of mine who was going into er (when i was a 2nd year med student) that i could never spend every day of my life in the er....

try not to get trapped -- for instance, some school have loans for primary care and if you don't go into primary care the interest rates are astronomical. be careful, you don't want to spend the rest of your life hating your job especially if you feel like you're being backed into it.

just my 2 cents

 

[jazz]

oh, one more thing, slickness
if those are your acceptances -- go to Temple. good school, good residency programs there.

 

[Adapt]

Originally posted by jazz
oh, one more thing, slickness
if those are your acceptances -- go to Temple. good school, good residency programs there.

Yes I know.

 

[kcrd]

Originally posted by jazz

i think until you rotate through the specialties, you won't know what you like. i entered med school knowing i wanted to be a doctor. thought IM for sure (i mean by pure stats -- highest number of people go into medicine) hated my medicine rotation.

I was certain that I would be doing primary care medicine before I started my rotations. After my 12 weeks of Internal Medicine, I know that I cannot see myself doing it for a living. You really need to see what these fields are like day in/day out for 60+ hours a week before you make up your mind. I never considered doing Psych until I started my rotations, and now it's at the top of my list.

ps - PM me if you have any questions about Temple.

 

[DrQuinn]

Knew I wanted to do Emergency Medicine before medical school, matched in EM, and will stay in EM my entire life (unless I become a pharmaceutical *****).

Q, DO

 

[Adapt]

Originally posted by QuinnNSU
Knew I wanted to do Emergency Medicine before medical school, matched in EM, and will stay in EM my entire life (unless I become a pharmaceutical *****).

Q, DO

Finally, someone that went against the grain. Nice Quinn.

 

[Seaglass]

It's not that we want you to change your mind Slickness; it's that you shouldn't paint yourself into a corner when you don't have to. I'm all for you coming out comitted to FP, God knows we need more of them. But God forbid you bet forced into FP if you find out you REALLY hate it. Could happen. I've seen it happen to friends of mine and some of my attendings. You can always get loan forbearance and relief from the health corps after med school. Same for the military - you can always join up after med school and get a good portion of the financial relief without the residency pressures.

The goal of medical school is NOT to change your mind. If you already have a pretty real impression of what FP is and how it differs from other specialties then you probably won't change. If for some reason your impressions of FP do not correspond well with reality then you might change your mind for some good reasons.

Casey

 

[womansurg]

I was convinced that I would do Internal Medicine - or some subspecialty of this - in an academic setting. I felt that Medicine was very 'cerebral' and that a person who was somewhat intellectual would find the greatest happiness there. Then I rotated on IM and found out that I despise rounding and and I despise writing notes - which seems to comprise the entire day of an internist.

Now I'm doing general/thoracic/vascular/trauma surgery in a community setting. I handle all my own post op critical care and often care for the sickest patients in the hospital. So I get to enjoy the systems based, investigative practices of medicine, while having the unbelievable enjoyment of practicing surgery.

 

[willow212]

Slickness,

It sounds like with the DO vs MD decision, you have already been thinking about what schools will gear you towards FP.

If you end up deciding between schools in either category, it would be nice for you to find out in advance how many people from the school match in FP, and what FP electives/sites they have (so you can tell how FP-geared that school is).

There are definitely some schools that can give you a much better FP experience than others.

At the same time, you also want to try to get a well-rounded experience in other specialties.

Even if you don't want to go into peds, ob/gyn, surgery, psych, IM, derm, radiology, ER, etc., I assume you will want to learn as much as possible about each field to help in your general practice.

 

[madcadaver]

Slicky, Slicky, Slicky...

It is my observation that most people who have the choice between MD and DO choose MD in order to expand their choices. Please don't choose to go DO expressly to limit your choices.

It's great that you are interested in FP. Get an FP advisor in your first year, try to do some extra FP shadowing or community clinic work in your first two years. Maybe get involved in some FP research (no, not an oxymoron). But for heaven's sake, keep your eyes open during your third year. There are MANY other opportunities out there that you don't even know about yet, but you're hiding from them like a scared little girl (my apologies if you are actually a scared little girl). Choices GOOD. No choices BAD.

I went into med school set on FP and chose internal medicine instead for a number of reasons. But those reasons would have been impossible for me to understand before I had done clinical rotations in both.

Good luck and here's to choices!
MadC

 

[madcadaver]

One more thing I forgot:

FOR HEAVEN'S SAKE, DO NOT CHOOSE ANY MEDICAL SPECIALTY JUST BECAUSE YOU CAN GET BETTER LOAN RATES!

Hard to believe it needed to be said.

For reference, the rate on my Direct Loans (the regular old federal loan program) is currently 3.42%. It is hard to get lower than this. It is not worth it.

MadC

 

[irlandesa]

went in with heart completely set on pediatrics; now want to do Internal Medicine and possibly subspecialize. Also have ended up enjoying my Surgery rotation a lot, so I haven't completely ruled that out yet either, much to my surprise. We'll see how it goes. My boyfriend is in his 2nd year at a DO school and is planning on going into IM or FP, but since he loves to teach Anatomy and his dad is a surgeon, I think he may well end up changing his mind too after hitting the wards next year (much to his dismay)! always good to keep an open mind..

 

[Molly Maquire]

I am an osteopathic medical student.

Here is a piece of advice: For the love of God, go to Temple.

 

[triathlete411]

Started elementary school knowing I wanted to be a surgeon. I am now five months into my five to seven year general surgery residency.

 

[drvlad2004]

When I entered osteopathic medical school, I had no intentions on entering a primary care field, although they try to push us in that direction. Guess what, I am still not interested in going into primary care, especially living in the Northeast. After all my 3rd year rotations rotations in IM, FP, and peds, I found out that none of these fields fit my traits whatsoever. Slickness, go into a field that fits you the most. You will swayed by many people, even those primary care loans which can rip-offs when interest rates are already low. Just go with your heart and guts. My long-standing interest in PM&R was confirmed this year through my 4th year electives.

Although I am proud in becoming a DO very soon, you should definitely choose Temple!

 

[Adapt]

Originally posted by Molly Maquire
I am an osteopathic medical student.

Here is a piece of advice: For the love of God, go to Temple.

I find it interesting that several DO students (of all people) recommend that I go to Temple instead. I like COMP because I live about half an hour away and basically I want to stay in southern CA for the rest of my life.

As a result, this is another major factor why I want to be an FP. There are about 20 programs in southern CA and they have a lot of graduates from COMP in their programs. However, I realize it would be hard to get a residency in southern CA in any other specialty especially as a DO. Yes, I know, I place too much emphasis on location at the expense of my future.

 

[Hop Toad]

Can't remember not wanting cardiology. Have to do the 3 years of IM to accomplish this goal. Feel that medicine is the thinking man's medical field. Surgeons are the technicians.

 

[drvlad2004]

Originally posted by Slickness
I find it interesting that several DO students (of all people) recommend that I go to Temple instead. I like COMP because I live about half an hour away and basically I want to stay in southern CA for the rest of my life.

Dude, I don't blame you for wanting to stay in SoCal. It's a wonderful area, especially San Diego!

 

[Su4n2]

Dr Vlad, Molly,

i am a first year at nycom, and seing how u guys are more in the know how, why this "go to temple" business? are u guys not happy with the education u received? just curious.

to the OP,
if u definately want FP, go DO. back pain is a very common complaint, and being able to give your patient an " axtra something" will be helpful both for them.

 

[Adapt]

Originally posted by Su4n2
Dr Vlad, Molly,

i am a first year at nycom, and seing how u guys are more in the know how, why this "go to temple" business? are u guys not happy with the education u received? just curious.

to the OP,
if u definately want FP, go DO. back pain is a very common complaint, and being able to give your patient an " axtra something" will be helpful both for them.

Yea, what's up with these DOs telling me to go MD. Where's the pride.

Anyways, I never thought about the back pain thing. I guess it would be an advantage in that sense to be a DO.

 

[drvlad2004]

Originally posted by Su4n2
Dr Vlad, Molly,

i am a first year at nycom, and seing how u guys are more in the know how, why this "go to temple" business? are u guys not happy with the education u received? just curious.

to the OP,
if u definately want FP, go DO. back pain is a very common complaint, and being able to give your patient an " axtra something" will be helpful both for them.

When I compare the places of where Slickness got accepted to, I simply see that Temple is the stronger and more established program on his list. TUCOM and COMP are still great schools. It does not have much to with MD vs. DO issue, which has been discussed ad nauseum.

The NYCOM has been good overall. Su4n2, I really can't compare my class (during 1st and 2nd year) to yours since I heard your curriculum has changed, especially with having a different dean. However, my education has benefited me tremendously in preparing myself for PM&R. BTW, back pain can be well-treated by PM&R. Add that with osteopathic skills, then you can be the man (or woman )!

 

[Lara]

slickness - I do understand your wanting to stay in SoCal...but Temple's an excellent clinical school! Students have the *option* of the competitive specialties, but a lot go into primary care. If you haven't seen the 2003 match list, take a look:
http://www.medschool.temple.edu/studentaffairs/pdf/Match_Results_03.pdf

Unless you're really keen on the osteopathic philosophy and manipulation (which is perfectly fine, but I'll emphasize the "really" again) I'd very much recommend your coming. You won't find a Temple student on this board who hates the school, despite the often lousy weather.

(But hey, early last week we had t-shirt weather - in November!!!)

 

[Teufelhunden]

Originally posted by Slickness
Yea, what's up with these DOs telling me to go MD. Where's the pride.

What pride? I went to DO school for one reason: MCAT: 27

Yeah, I didn't get into an MD school, and was too old to play the re-test and re-apply game.

Listen, anyone with acceptances to both MD and DO schools should go the MD route...I'm just being honest.

There's more opportunities for MD grads, period. The only exception is if you're 100% certain you want to do FP...then it doesn't really matter.

 

[Adapt]

Originally posted by Teufelhunden
What pride? I went to DO school for one reason: MCAT: 27

There are lots of people with a 27 MCAT that make MD schools. I got a 29, which isn't that far from 27, and was fortunate to get into one.

Lara, I know that Temple is a nice school and they do have an excellent clinical education. It's a tough decision.

 

[jazz]

as you know, temple is a great school -- strong clinical training.

having a MD will provide more opportunities and make life somewhat easier when applying (vs a DO)

however, compared to southern cal, philly will suck. the weather sucks. patients can be painful in many ways (unthankful, demanding, don't take care of their own health, don't follow up, are mistrustful, angry, etc). you'll see a lot of that, especially at temple. if you think you can bear four years in philly, i would strongly consider temple for the opportunities it can afford you. who knows, as stated earlier, a lot of people end up in fields that they would never have dreamed of when starting school.

 

[NebelDO]

It doesnt matter if you are a DO or an MD..You can do whatever speacialty you want.True most DO's go into FP IM ER OBGYN. I myself did not get into an MD school either but after i learned more about what we do and have seen it work and used it on myclassmates and patients, im proud that im going to be a DO. I have no plans for primary care. My interests are in Surgery, Uro, Trauma, and Transplant. even though these specialties do not have many indications for OMM i will use them when i can.

I think you should listen to your gut feelings and go whereever it tells you to go.

just my 2 cents

 

[Teufelhunden]

Originally posted by NebelDO
It doesnt matter if you are a DO or an MD..You can do whatever speacialty you want.

True, you "can" do what ever specialty you want with a DO, but your options are limited when compared with your MD counterparts.

Listen, DOs are represented in every medical specialty and sub-specialty. And, of course, it is possible to get into any field you choose. However, all things being equal, your chances of getting into a competitive allopathic program are better with an MD degree.

Thats why I said, if you're undecided about which specialty you're interested in, and have the option between MD and DO...take the MD because it may give you more options later.

Remember, there are still programs out that that have never accepted a DO into their ranks. That's just an unfortunate fact of life for us DOs, and I would be amiss not to be honest about this fact when giving advice to those in position to make a choice.

 

[Adapt]

Originally posted by flindophile
It sounds almost as if you feel there is something important or virtuous about not changing your mind.

Here is a good lesson from a former MBA teacher: options have value. That is why people pay money for them. Your actions are equivalent to tearing up money. Is this strategy effective in other areas of your life?

In the words of a song by some famous rappers "...Mo money, mo problems..."

That is, to me it's not about the money. As long as I can lead a decent life as a doctor I will. This is one of the reasons why I see FP as a good field even though they get paid the least.

However, I would say I don't like to change my mind. I'm the type of person that sets on a goal and sticks with it. I don't see how I would be "tearing up money" by not changing my mind in this case. I guess I wouldn't be making as much if that's what you mean.