Lost, confused MS3 looking for advice

[TheRealReel]

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Here's some background:

Preclinical grades are fine, clinical grades mix of HP and Honors (Honors in Psych, Surgery, Outpatient Medicine, Radiology and HP in Medicine, Peds, OB/GYN), 252 Step 1, at a top 20 med school. I basically have no research (one abstract in ortho) and a few extracurriculars from preclinical. Not AOA.

I was mostly miserable during clerkship year due to being depressed and hating the constant performative aspect of most rotations, but I enjoyed psych, medicine and radiology the most. I was thinking about urology for a few months, and am currently on a sub-i, but am not really digging it too much. As we start to roll through May, my anxiety is starting to get worse and I'm feeling more lost. I have recently come to the realization that I'm not terribly interested in doing academics, and really just want to be a kickass community physician. Not that I don't enjoy fast-paced, continually evolving fields (I do!), I just don't particularly enjoy the work of data-collecting and writing. I would also like some say in geography, as I'd like to end up on the west coast.

Medicine: I wasn't that into my inpatient medicine rotation, but I did enjoy the process of developing a differential and the amount of patient interaction it afforded. Going through fellowship in GI or cards could give me the procedural aspect that I want, as well, but applying into medicine with the intention of moving on to fellowship seems risky as it's not guaranteed, and I would not enjoy my job if I was just an internist/primary care doc. Also, given my HP in my core medicine rotation, I'm not sure what caliber of IM residency I would be able to get (most of my attendings gave me great comments and I could definitely get letters, just my shelf score that brought me down to a HP... the clerkship director actually told me that I was two points away from the honors cut-off. Clearly, I'm not still salty about this), which would affect my chances of getting a fellowship position, I imagine.

Urology: What I've been considering for a bit. As an attending, it seems like you get good control over how much clinic time you want, and the types of surgeries you perform (you can go with bigger surgeries ex nephrectomies and prostates, or stick to smaller quality of life procedures like stones, TURPs and slings). I like the patient population and the fact that most of the time, your interventions make people feel better quickly. Few emergencies, as well. Job market is great, too. Like medical specialties, I would get to have longer-term follow-up with patients, which is a plus for me. Downsides include residency, which is mostly surgery (from what I've gathered), and long surgeries bore me to tears. I generally dislike most surgery, but I love the smaller procedures like stone removal, TURPs and TURBTs, green light prostate ablations, etc, so I imagine residency would be an absolute slog. I've already started working on research in the chance I try applying, but that unmatched rate freaks me out. My PD and another senior attending who works on admissions said I should be fine and I could match somewhere as long as I get my aways in order and have SOME research to put on my CV by the time I apply so I can talk about it in interviews, but... I would probably have to backup apply to something else, just in case. Going unmatched and having to SOAP is my worst nightmare.

Psychiatry: I genuinely loved my psych rotation. Lovely people and the patients are among the most interesting in medicine (to me, at least). Seeing as I've suffered from depression, anxiety and OCD in the past, I felt more empathy towards psych patients in general. While patient compliance seems like it would be frustrating, knowing that you can completely change one's worldview for the better stands out as one of the coolest things in medicine. Acceptance of psychiatrists and mental health in general is on the upswing, and I imagine psych is going to be booming in the near future. And, in honesty, lifestyle is a plus, and I might have a bit more say in geographical location if I apply psych. I would find it appealing to be in clinic most of the week, then be on-call as consult liaison for a couple of days to put on a white coat and interface with the more "medicine-y" aspects of psych. Downsides include the possibility of psychologists encroaching on the field with prescription rights, the aforementioned patient compliance issues, and the lack of "quick-fixes" that urology can give.

Rads: Radiology is pretty different than most of the other things I listed, but I actually really like imaging and being a core component of pretty much every field in medicine. I'm fascinated by how much you can learn about a patient from their imaging, and the work seems very intellectually stimulating. Lifestyle and compensation is great (for now), and I've been in awe of how much the radiology attendings know about pathophysiology. I thought about IR for a bit, too, as you get to do many small-ish procedures and have more patient interaction, but it seems that even as a diagnostic radiologist, you can do procedures if you want to (particularly in body imaging and nuclear medicine). Major con is lack of patient interaction, but there is plenty of collaboration with other fields that rely on your reports, and IR is making a push for more clinic time (at least, in my experience so far). I know IR is extremely competitive, but since I wouldn't be ready to commit to IR, I would most likely apply DR and try to go for programs that offer early specialization in IR tracks, just to keep the option open.

Derm: I might enjoy derm since it combines procedures, patient interaction, you can have long term follow up with patients with chronic inflammatory conditions like psoriasis, treat and prevent melanoma, and have a great lifestyle to boot. And as someone with chronic allergies and eczema, I know that skin stuff sucks ass and my self-esteem improves dramatically when my skin doesn’t look gross. I just never thought I would be able to do it since it’s such a bloodbath... but I guess it’s not that much of a jump from urology to derm in terms of competitiveness, I guess?

I wouldn’t mind taking a research year to fill out my anemic CV (I mean, it’s pretty bad, my step 1 score is basically the only thing I have going for me) since this is the rest of my life, you know? One more year in the big scheme of things is not that much more of a sacrifice. And I would still be able to backup apply to psych since I can make a good case for wanting it, I think. Plus, my school has a very highly regarded derm program with some big names, and I think on the whole, we match people to derm regularly. Would not gunning for derm from day 1 of med school hurt me, if I would just want to match derm somewhere?

So, I think it's clear I'm still trying to figure some stuff out, and it's May of my third year, so I'm low-key freaking out. Has anyone been in a position where they are trying to choose between things that might be drastically different? How has it worked out? Any advice would be appreciated.

 

[Aurum]

I too struggled between a couple different specialities during early fourth year and ended up choosing the most competitive one (DR) of the bunch. Everything turned out fine and I matched at a top program, so you have time.

You're correct in your assessment that a HP in medicine will hurt you for interviews. You'll still get interviews at programs with great training and decent names, but cracking the top 20 is not guaranteed. You can match cards or GI no problem coming out of programs outside the top 20 of course, I'm just not sure how critical program prestige is to you. Furthermore, it doesn't seem like you enjoyed IM itself, just the possibility of doing cards or GI.

It sounds like you liked Rads or Psych the best out of the lot. I'd do rotations in both at a more advanced level and see how you feel. DR is far more competitive than psych and regional bias was very strong this year. If you're dead set on the West Coast and don't have strong ties to the area it would be far easier to match psych there. Both are solid choices in terms of specialty.

 

[Oso]

Sounds like you enjoyed psych and rads the most. Try to do electives in them in early summer and see which you prefer. If you don’t enjoy inpatient IM then residency would be miserable. Without any research in urology you’d probably need to take a research year to be competitive. Honestly sounds like you enjoy psych and rads the most though. $0.02

 

[BigRedBeta]

You're a bit more discordant than most at this stage and I'm curious what it is about urology that stands out compared to other surgical specialties. However there are a lot more people than you think who come down between surgery and psychiatry.

First, decide how much you need the OR in your life - given your other interests, doesn't seem important. While it's not always true, people that don't LOVE the OR generally become miserable upon entering surgical fields. The personalities and culture can be too much if you don't find the payoff of being in the OR

Next I usually tell students to decide on patient population (adults vs kids, or women only). Seems like you're squarely with adults only.

Third - generalist or single organ system? The followup question is of course what organ and why? General surgery, critical care, psych, PM&R and radiology fit the more general side of the coin, whereas cardiology, GI, and the surgical subspecialties hit the other. I think it's important to focus mostly on the pathology you like seeing, before you get into job market, procedures, limiting yourself to certain types of patients. Residency is going to expose you to the breadth and you'll be a better resident if you embrace the entirety of the field - the best subspecialists start out as the best generalists.

If you've ruled out the OR, then next is frequency of procedures, although I hesitate to list that at all. The fact is that once you're an attending and have done these things hundreds to thousands of times, it tends to become routine. One of my friends in anesthesia told me that when he was a student it made his week when he got an intubation on the first attempt but by the time he finished residency he was beating himself up for days if he missed his first attempt on what he thought should have been an easy go.

I guess from what you've written, I don't see that you're a budding urologist, and it almost seems like inertia (maybe because of your high step 1 score?) more than anything has kept that in the running to this point. As the others have noted, you have the most positive things to say about psych and rads. So then it comes down to patient interaction, of which these two fields are on opposite ends of the spectrum. I get the sense that you like seeing patients and enjoy the feeling of seeing them improve - that's hard (but not impossible) to get from of a DR residency.

Hope this helps

 

[operaman]

Based on your post I’d say commit to psych 100%. It’s the only one where you gave any indication you actually like the day to day work of the field. If you don’t love operating you need to eliminate all surgical fields, period. It just isn’t worth the hassle if you don’t even like the best part and even the good surgical lifestyles like uro will pale in comparison to the lifestyle in other fields.

Psych is also a field with many advances looming on the horizon. TCMS and fMRI and the like are poised to revolutionize many treatments and the medical and therapeutic options keep getting better too.

In the end, you’ve got to decide what you want to do with your working hours. You seem to like the idea of the other fields but you actually seem to like the work of psychiatry. Do that. The money is good. Lifestyle is great. Options are endless.

 

[Skiiiiiing]

Psych's future is among the strongest in medicine, IMO. Midlevels aren't going to provide any more comeptition than they do, AI can't touch it, mental illness rising sharply among a certain group of people collectively repudiating the wisdom of Seneca, Montaigne, Christ in midst of neurotic attempts to control others.

Rads has severe AI vulerability. There are a couple AIs already that are getting fast-tracked through the FDA. Long term there is least certain in medicine.

With respect to depression, are you sure it's not just the emotions of getting through a tough adjustment period? Is there something outside of medicine you want to do? I know it sucks, but you can either grit through it or treat it - I don't think a short or even medium term depression in this context is much of a signal.

 

[Cyphix]

Do you enjoy being in the OR? Urology residency would be a slog if you don't love the OR, as you will be operating a lot.

From what you wrote it seems like Psych is a good fit - interest in the pathology, good work-life balance, longitudinal patient relationships, etc.

 

[TheRealReel]

Thanks for all the advice, guys. If I end up doing rads, would I have to take a research year to be competitive for good schools in California (UCLA, UCSF, etc), given that rads is getting more competitive? I have ties to the general geographic area (I'm from Reno), not quite sure if that would help me out.

 

[Cognovi]

Thanks for all the advice, guys. If I end up doing rads, would I have to take a research year to be competitive for good schools in California (UCLA, UCSF, etc), given that rads is getting more competitive? I have ties to the general geographic area (I'm from Reno), not quite sure if that would help me out.

No. Taking research years is a minority path even in the top programs. Do research if you love research.

 

[Taddy Mason]

I agree with others that psych sounds like the best fit. Also, I wouldn’t worry at all about “psychology enroachment” which honestly really isn’t even a thing. Most psychologists are content without and don’t want prescribing privileges. Currently only 5 states allow psychologists prescribing privileges and these states have a significant shortage of psychiatrists, are largely rural, and/or have a large indigent population. They’re a vital component to mental healthcare as a whole and provide services that psychiatrists don’t receive training for in residency.

 

[trobinsonmd]

If you know you can pump out a lot of research in a year, I would take the research year and apply derm... I am in derm and I love it, although there are some other amazing options as well. Sounds like you don't particularly like long procedures, so not sure if urology is the play as some of the procedures run on the longer end. wrt rads, I don't know a ton about it, but I do know that the job outlook is a bit dicey due to some AI developments and outsourcing films to other countries... I think if one were to do rads, they would have to do IR so they are not replaceable in my opinion... not saying that diagnostic radiologists are replaceable, but I just think the demand might go down for them

 

[sloop]

TCMS and fMRI and the like are poised to revolutionize many treatments and the medical and therapeutic options keep getting better too.

Totally agree that OP should go with psych. I love what I do and I think psych is by far the most exciting, stimulating area of medicine with a great lifestyle and lots of career options.

That said, do you really believe the above quote? I think fMRI has huge research potential and there may well be breakthroughs related to this in the future. I have less objection to lauding fMRI as a promising tool.

TMS, though . . . I think TMS is a decent new tool and is promising, but my understanding of and experience with patients treated with TMS is that it's a good option, but not an amazing one. It's better tolerated but the results are still poor compared to more mature brain stimulation technologies, namely ECT. People fairly routinely fail TMS and have to get ECT. It's valuable in that we can do staged therapy in more stable patients and save those who respond well to TMS from the memory loss involved with ECT but I don't see this revolutionizing psychiatry (even granting that TMS is far from a mature technology).

 

[Taddy Mason]

Totally agree that OP should go with psych. I love what I do and I think psych is by far the most exciting, stimulating area of medicine with a great lifestyle and lots of career options.

That said, do you really believe the above quote? I think fMRI has huge research potential and there may well be breakthroughs related to this in the future. I have less objection to lauding fMRI as a promising tool.

TMS, though . . . I think TMS is a decent new tool and is promising, but my understanding of and experience with patients treated with TMS is that it's a good option, but not an amazing one. It's better tolerated but the results are still poor compared to more mature brain stimulation technologies, namely ECT. People fairly routinely fail TMS and have to get ECT. It's valuable in that we can do staged therapy in more stable patients and save those who respond well to TMS from the memory loss involved with ECT but I don't see this revolutionizing psychiatry (even granting that TMS is far from a mature technology).

The TMS data is tenuous. It will be interesting to see where the ketamine trend goes and how beneficial it proves to be. As for fMRI I’m really interested in the potential of what 7+ T MRIs will be able to add to our understanding of basic neuroscience, neurological disorders, and mental illness and potential treatments.

 

[sloop]

The TMS data is tenuous. It will be interesting to see where the ketamine trend goes and how beneficial it proves to be. As for fMRI I’m really interested in the potential of what 7+ T MRIs will be able to add to our understanding of basic neuroscience, neurological disorders, and mental illness and potential treatments.

I've had a couple patients I referred to ketamine trials my institution does and I felt weird about it in both cases. It's exciting for me to be involved in the care of patients getting these things done and get some experience in how this works, but I feel like a snake oil salesman (except for some reason this stuff seems to sell itself). I think the data on this is super preliminary and it's hard for me to honestly portray it as predictably having benefit, even on average. The times I've done this have been the patient's idea and they for whatever reason can't or won't pursue ECT or TMS.

 

[hmockingbird]

Another vote for psych. Your writing changed when I got to that paragraph.

 

[Zachilles Calcaneus]

Stumbled upon this thread amid the dialectical movements of my own either/or. similar stats. we've come to a fork in the road in a land immersed in fog. I simultaneously feel that i like everything and nothing, that therefore i would be happy going into anything. and yet theres a hang up. i simply cannot tip the scale. There are a few arguments lurking in the shadows that deserve illumination, gravitating around the empirical observation that every persons job programs who they are. psychiatry and radiology will draw out very different dimensions of personality. Its interesting how so many people 'vote psych' but you suggest you lean towards radiology. i get that. radiology is safe, psych is perilous! frightening! political! murky! taboo! you engage the underbelly of society. you are in contact with the crucible of culture, the boundary of reality. it is the path less chosen because 99% of people out there have psychophobia- fear of the mind. rightly so. if you put anything less than your entire body into it, you will get lost and it will break you. and so when you tell people your going into psychiatry they look you you like you're some odd fellow on a deluded quest, but you don't want to be an odd fellow! Lets be honest- psychiatrists are weird! who would choose that path? who would hold that pose? Its a look that suits some more than others depending on how you deal with the awesome suffering of your patients, but no matter what, working in a psych ward for any amount of time will change you no matter how resilient you are. but isnt that the point? to expose yourself to the suffering? to fight for those in need? to take on as much as you can with no expectation of reciprocity? to deepen your sympathy in spite of the pain endured? Whips! Scorns! Slings and arrows! please give me sanctuary from the brutality that is reality! Alas! Alas! the basement at last! Radiology! (oddly womb like- warm, quiet, abundant resources, zero struggle). Imagine a modern retelling of Siddhartha/med student who does psych rotation, becomes clinically depressed due to the overwhelming suffering of millions, growing by the day, and so founds spiritual practice to transcend suffering. Suffering is to psych as enlightenment is to radiology, the hidden specialty that students discover some time during third year when they: 1) realize that modern medicine basically is imaging, 2) that reading abdominopelvic ct's is fun/aesthetic, 3) they're feeling jaded about their clinical rotations, potentially even regretting their choice to go into medicine, 4) calculate the money : suffering ratio. seriously how can you turn down radiology. its right there for the taking, this hidden gem and you realize it and think like, ok don't tell anyone about this because this is it, this solves the problem. but its a cop out. yeah, it is interesting. all the big machines and proof and fluency of jargon. It really seems like they are one of the only ones who can enter into flow while theyre pumping out reads in the dark, and that has immense appeal. feeling like your really good at your job and being rich rich rich. but would it even be an option if they made as much as in psych? there is nothing specific to who you are that makes a difference in radiology. you are entirely replaceable, the epitome of a cog in the medical machine. and yet its almost irresistible. i think we have a tendency to underestimate how much we actually crave repetition. that the variation within the repetition of psychiatry is too much. how much suffering are you will to take on? radiologists are rewarded to suffer the least. or is the dark room the ultimate suffering? solipsism, death in life? I alternate between telling people im going into psych and going into rads. The difference in reaction is fascinating. With psych, they seem a bit confused, like why would you want to work with crazy people, or maybe offended because they had some negative experience and now are firmly anti-psychiatry. let it be known: the anti-psychiatry movement is the life blood that mainstream psychiatry depends on for the appropriation of new techniques. see the ketamine trials, second wave psychedelic movement, neuropsychoanaysis, etc. they typically think that you must be crazy, or have some odd fetish for the weird. with radiology people don't have much to say, besides 'ohh money, very wise', or something to the effect of- every career becomes a mindless repetition, so you might as well get the most buck for your bang. My parents secretly loathe the idea of their doctor son going into psychiatry. their eyes light up when they hear me say radiology. The idealist (re: masochist??) in me wants psychiatry, while the pragmatist (re: coward???) wants radiology. i cannot help but feel that if i were to choose radiology, there would be a certain measure of guilt i would have to overcome that would not be there in psychiatry. this post keeps going but arbitrarily ends here...

 

[Osminog]

Stumbled upon this thread amid the dialectical movements of my own either/or. similar stats. we've come to a fork in the road in a land immersed in fog. I simultaneously feel that i like everything and nothing, that therefore i would be happy going into anything. and yet theres a hang up. i simply cannot tip the scale. There are a few arguments lurking in the shadows that deserve illumination, gravitating around the empirical observation that every persons job programs who they are. psychiatry and radiology will draw out very different dimensions of personality. Its interesting how so many people 'vote psych' but you suggest you lean towards radiology. i get that. radiology is safe, psych is perilous! frightening! political! murky! taboo! you engage the underbelly of society. you are in contact with the crucible of culture, the boundary of reality. it is the path less chosen because 99% of people out there have psychophobia- fear of the mind. rightly so. if you put anything less than your entire body into it, you will get lost and it will break you. and so when you tell people your going into psychiatry they look you you like you're some odd fellow on a deluded quest, but you don't want to be an odd fellow! Lets be honest- psychiatrists are weird! who would choose that path? who would hold that pose? Its a look that suits some more than others depending on how you deal with the awesome suffering of your patients, but no matter what, working in a psych ward for any amount of time will change you no matter how resilient you are. but isnt that the point? to expose yourself to the suffering? to fight for those in need? to take on as much as you can with no expectation of reciprocity? to deepen your sympathy in spite of the pain endured? Whips! Scorns! Slings and arrows! please give me sanctuary from the brutality that is reality! Alas! Alas! the basement at last! Radiology! (oddly womb like- warm, quiet, abundant resources, zero struggle). Imagine a modern retelling of Siddhartha/med student who does psych rotation, becomes clinically depressed due to the overwhelming suffering of millions, growing by the day, and so founds spiritual practice to transcend suffering. Suffering is to psych as enlightenment is to radiology, the hidden specialty that students discover some time during third year when they: 1) realize that modern medicine basically is imaging, 2) that reading abdominopelvic ct's is fun/aesthetic, 3) they're feeling jaded about their clinical rotations, potentially even regretting their choice to go into medicine, 4) calculate the money : suffering ratio. seriously how can you turn down radiology. its right there for the taking, this hidden gem and you realize it and think like, ok don't tell anyone about this because this is it, this solves the problem. but its a cop out. yeah, it is interesting. all the big machines and proof and fluency of jargon. It really seems like they are one of the only ones who can enter into flow while theyre pumping out reads in the dark, and that has immense appeal. feeling like your really good at your job and being rich rich rich. but would it even be an option if they made as much as in psych? there is nothing specific to who you are that makes a difference in radiology. you are entirely replaceable, the epitome of a cog in the medical machine. and yet its almost irresistible. i think we have a tendency to underestimate how much we actually crave repetition. that the variation within the repetition of psychiatry is too much. how much suffering are you will to take on? radiologists are rewarded to suffer the least. or is the dark room the ultimate suffering? solipsism, death in life? I alternate between telling people im going into psych and going into rads. The difference in reaction is fascinating. With psych, they seem a bit confused, like why would you want to work with crazy people, or maybe offended because they had some negative experience and now are firmly anti-psychiatry. let it be known: the anti-psychiatry movement is the life blood that mainstream psychiatry depends on for the appropriation of new techniques. see the ketamine trials, second wave psychedelic movement, neuropsychoanaysis, etc. they typically think that you must be crazy, or have some odd fetish for the weird. with radiology people don't have much to say, besides 'ohh money, very wise', or something to the effect of- every career becomes a mindless repetition, so you might as well get the most buck for your bang. My parents secretly loathe the idea of their doctor son going into psychiatry. their eyes light up when they hear me say radiology. The idealist (re: masochist??) in me wants psychiatry, while the pragmatist (re: coward???) wants radiology. i cannot help but feel that if i were to choose radiology, there would be a certain measure of guilt i would have to overcome that would not be there in psychiatry. this post keeps going but arbitrarily ends here...

Write using paragraphs

 

[Premed2295]

Read your own descriptions again now as you are coming closer to the time to apply to residency. As an outsider looking in reading this, it seems like psych was your passion. Do that!

let this serve as a notification for you that forces you to look back at what you wrote. Best of luck

 

[Cognovi]

Stumbled upon this thread amid the dialectical movements of my own either/or. similar stats. we've come to a fork in the road in a land immersed in fog. I simultaneously feel that i like everything and nothing, that therefore i would be happy going into anything. and yet theres a hang up. i simply cannot tip the scale. There are a few arguments lurking in the shadows that deserve illumination, gravitating around the empirical observation that every persons job programs who they are. psychiatry and radiology will draw out very different dimensions of personality. Its interesting how so many people 'vote psych' but you suggest you lean towards radiology. i get that. radiology is safe, psych is perilous! frightening! political! murky! taboo! you engage the underbelly of society. you are in contact with the crucible of culture, the boundary of reality. it is the path less chosen because 99% of people out there have psychophobia- fear of the mind. rightly so. if you put anything less than your entire body into it, you will get lost and it will break you. and so when you tell people your going into psychiatry they look you you like you're some odd fellow on a deluded quest, but you don't want to be an odd fellow! Lets be honest- psychiatrists are weird! who would choose that path? who would hold that pose? Its a look that suits some more than others depending on how you deal with the awesome suffering of your patients, but no matter what, working in a psych ward for any amount of time will change you no matter how resilient you are. but isnt that the point? to expose yourself to the suffering? to fight for those in need? to take on as much as you can with no expectation of reciprocity? to deepen your sympathy in spite of the pain endured? Whips! Scorns! Slings and arrows! please give me sanctuary from the brutality that is reality! Alas! Alas! the basement at last! Radiology! (oddly womb like- warm, quiet, abundant resources, zero struggle). Imagine a modern retelling of Siddhartha/med student who does psych rotation, becomes clinically depressed due to the overwhelming suffering of millions, growing by the day, and so founds spiritual practice to transcend suffering. Suffering is to psych as enlightenment is to radiology, the hidden specialty that students discover some time during third year when they: 1) realize that modern medicine basically is imaging, 2) that reading abdominopelvic ct's is fun/aesthetic, 3) they're feeling jaded about their clinical rotations, potentially even regretting their choice to go into medicine, 4) calculate the money : suffering ratio. seriously how can you turn down radiology. its right there for the taking, this hidden gem and you realize it and think like, ok don't tell anyone about this because this is it, this solves the problem. but its a cop out. yeah, it is interesting. all the big machines and proof and fluency of jargon. It really seems like they are one of the only ones who can enter into flow while theyre pumping out reads in the dark, and that has immense appeal. feeling like your really good at your job and being rich rich rich. but would it even be an option if they made as much as in psych? there is nothing specific to who you are that makes a difference in radiology. you are entirely replaceable, the epitome of a cog in the medical machine. and yet its almost irresistible. i think we have a tendency to underestimate how much we actually crave repetition. that the variation within the repetition of psychiatry is too much. how much suffering are you will to take on? radiologists are rewarded to suffer the least. or is the dark room the ultimate suffering? solipsism, death in life? I alternate between telling people im going into psych and going into rads. The difference in reaction is fascinating. With psych, they seem a bit confused, like why would you want to work with crazy people, or maybe offended because they had some negative experience and now are firmly anti-psychiatry. let it be known: the anti-psychiatry movement is the life blood that mainstream psychiatry depends on for the appropriation of new techniques. see the ketamine trials, second wave psychedelic movement, neuropsychoanaysis, etc. they typically think that you must be crazy, or have some odd fetish for the weird. with radiology people don't have much to say, besides 'ohh money, very wise', or something to the effect of- every career becomes a mindless repetition, so you might as well get the most buck for your bang. My parents secretly loathe the idea of their doctor son going into psychiatry. their eyes light up when they hear me say radiology. The idealist (re: masochist??) in me wants psychiatry, while the pragmatist (re: coward???) wants radiology. i cannot help but feel that if i were to choose radiology, there would be a certain measure of guilt i would have to overcome that would not be there in psychiatry. this post keeps going but arbitrarily ends here...

Psych seems like a good fit

 

[Ole_Toe]

Stumbled upon this thread amid the dialectical movements of my own either/or. similar stats. we've come to a fork in the road in a land immersed in fog. I simultaneously feel that i like everything and nothing, that therefore i would be happy going into anything. and yet theres a hang up. i simply cannot tip the scale. There are a few arguments lurking in the shadows that deserve illumination, gravitating around the empirical observation that every persons job programs who they are. psychiatry and radiology will draw out very different dimensions of personality. Its interesting how so many people 'vote psych' but you suggest you lean towards radiology. i get that. radiology is safe, psych is perilous! frightening! political! murky! taboo! you engage the underbelly of society. you are in contact with the crucible of culture, the boundary of reality. it is the path less chosen because 99% of people out there have psychophobia- fear of the mind. rightly so. if you put anything less than your entire body into it, you will get lost and it will break you. and so when you tell people your going into psychiatry they look you you like you're some odd fellow on a deluded quest, but you don't want to be an odd fellow! Lets be honest- psychiatrists are weird! who would choose that path? who would hold that pose? Its a look that suits some more than others depending on how you deal with the awesome suffering of your patients, but no matter what, working in a psych ward for any amount of time will change you no matter how resilient you are. but isnt that the point? to expose yourself to the suffering? to fight for those in need? to take on as much as you can with no expectation of reciprocity? to deepen your sympathy in spite of the pain endured? Whips! Scorns! Slings and arrows! please give me sanctuary from the brutality that is reality! Alas! Alas! the basement at last! Radiology! (oddly womb like- warm, quiet, abundant resources, zero struggle). Imagine a modern retelling of Siddhartha/med student who does psych rotation, becomes clinically depressed due to the overwhelming suffering of millions, growing by the day, and so founds spiritual practice to transcend suffering. Suffering is to psych as enlightenment is to radiology, the hidden specialty that students discover some time during third year when they: 1) realize that modern medicine basically is imaging, 2) that reading abdominopelvic ct's is fun/aesthetic, 3) they're feeling jaded about their clinical rotations, potentially even regretting their choice to go into medicine, 4) calculate the money : suffering ratio. seriously how can you turn down radiology. its right there for the taking, this hidden gem and you realize it and think like, ok don't tell anyone about this because this is it, this solves the problem. but its a cop out. yeah, it is interesting. all the big machines and proof and fluency of jargon. It really seems like they are one of the only ones who can enter into flow while theyre pumping out reads in the dark, and that has immense appeal. feeling like your really good at your job and being rich rich rich. but would it even be an option if they made as much as in psych? there is nothing specific to who you are that makes a difference in radiology. you are entirely replaceable, the epitome of a cog in the medical machine. and yet its almost irresistible. i think we have a tendency to underestimate how much we actually crave repetition. that the variation within the repetition of psychiatry is too much. how much suffering are you will to take on? radiologists are rewarded to suffer the least. or is the dark room the ultimate suffering? solipsism, death in life? I alternate between telling people im going into psych and going into rads. The difference in reaction is fascinating. With psych, they seem a bit confused, like why would you want to work with crazy people, or maybe offended because they had some negative experience and now are firmly anti-psychiatry. let it be known: the anti-psychiatry movement is the life blood that mainstream psychiatry depends on for the appropriation of new techniques. see the ketamine trials, second wave psychedelic movement, neuropsychoanaysis, etc. they typically think that you must be crazy, or have some odd fetish for the weird. with radiology people don't have much to say, besides 'ohh money, very wise', or something to the effect of- every career becomes a mindless repetition, so you might as well get the most buck for your bang. My parents secretly loathe the idea of their doctor son going into psychiatry. their eyes light up when they hear me say radiology. The idealist (re: masochist??) in me wants psychiatry, while the pragmatist (re: coward???) wants radiology. i cannot help but feel that if i were to choose radiology, there would be a certain measure of guilt i would have to overcome that would not be there in psychiatry. this post keeps going but arbitrarily ends here...

This is completely insane but perfectly captures the decision I’m trying to make between the fields. Well done.

 

[psyspy]

OP why have you ruled out anesthesia? If you really want to stay within medicine, rads will keep you there the most

 

[TelemarketingEnigma]

OP why have you ruled out anesthesia? If you really want to stay within medicine, rads will keep you there the most

OP might even be done with residency by now - this is an old thread from 2018 that got bumped