M3 debating future plans

[AABB999]

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Long story short, I made the decision to go to medical school over pursuing a PhD in my college major (a humanity) because I wanted to impact the lives of more than just the few students who'd take my classes and because I was intimidated by the financial/job instability associated with academia in a shrinking humanities field. I took several years of postbacc classes/work, and am a few months away from finishing M3 now. Maybe it's just M3 talking, but I realize now that was probably a mistake, as I miss the humanities and my interest in medicine has waned somewhat. I'm now in my late 20s, and M3 has left with me no concrete answers over what field to pursue and how to form a career in which I can be happy. I don't want to slave though a residency just to become an unhappy attending in my mid-30s. I have done no electives and am still looking into other specialties, but am very apprehensive about the future. I'm a strong student and am doing fine, but am profoundly burned and right now don't really seen a resolution to that down the road.

I want to try to salvage my life into something that makes me happy. I want time to write, and I'd be happy to teach - I really enjoy it and have prior paid experience in it, both at my postbacc institution and at a private company. Medically, I am most interested in ethics, patient decision-making, palliative care/how people deal with debilitation/death, chronic pain, etc, as well as the psyche of medical students/physicians; for example, a more medically-oriented version of something like the Theater of War (you'll have to google, I can't link) would fall into my wheelhouse. I have non-medical interests too, and would love to incorporate those academically if I could get an academic foot in the door.

I realize it'd be imprudent to drop out now, but part of me wonders whether I should apply for residency. With an MD, I think I would enjoy teaching some classes on the above topics to med students (or undergrads) at a university, doing something in medical education policy at a med school, and maybe running a support group - I went into medicine wanting to help people with these issues, and still do. I have no idea whether I could even do that without an academic degree, or how I'd go about getting involved in that.

I also wonder if it'd be better to try a residency in something like PM&R/palliative med (electives in which I will take before application deadline) and try to find part-time (or full-time) work that appeals to me and affords me time to do the above. I realize any residency doesn't really have a ton of free time to work on an academic portfolio, but that might be fulfilling for me. Also, this would make paying off loans a lot easier, and I might end up liking the work. I would be OK with the massive pay cuts associated with part-time/academia. However, another 4+ year commitment is intimidating to me given how the ~8 months of M3 have gone.


I guess I'd appreciate any insight from anyone who had to make a similar decision. I realize this insight would've been best had years ago, but I'd rather think about it now than when it's even more too late. I'll try to find time to find relevant connections at my institution, but would love any advice.

 

[siliso]

Interest in the humanities is an asset for a physician. You’re doing well in your studies, that leaves your options open. Do a residency in IM and be fascinated by the experience with the extremes of the human condition and write a book about it. Take a fellowship in ethics or palliative or both and do research and teach on ethics and philosophy or medical humanities or history. All of this easier to arrange if you complete your degree and an academic residency where you can get some experience in research and teaching. Certainly faster at this point than dropping out for a PhD. 2 cents only.

 

[AABB999]

Interest in the humanities is an asset for a physician. You’re doing well in your studies, that leaves your options open. Do a residency in IM and be fascinated by the experience with the extremes of the human condition and write a book about it. Take a fellowship in ethics or palliative or both and do research and teach on ethics and philosophy or medical humanities or history. All of this easier to arrange if you complete your degree and an academic residency where you can get some experience in research and teaching. Certainly faster at this point than dropping out for a PhD. 2 cents only.

I had no idea ethics fellowships existed, and based on the findings of five minutes of googling, you have have just really helped me. Thanks. Any resources on this?

I didn't like my IM rotation, but at least it's a short residency. I do think doing a residency is probably the best choice, just figuring out the details is my issue.

 

[siliso]

It is comparatively short and honestly if you are a nerd who is interested in people’s stories (I wager you are) you can really enjoy it or at the very least tolerate it. Not sure what aspects of your experience in clerkship you didn’t like, maybe I could advise more if I did know. I don’t know where you are, I only know the resources close to me personally, but there are plenty of medical ethics fellowships out there.

 

[mk04447]

M3 as well and I have a lot of classmates who feel as you do. Fortunately or unfortunately, depends how you look at it, I am nearly 2 decades older than you and I've seen the other side. I'm not sure what you, and many others, thought medicine would be. I get the feeling many thought it wouldn't be work, long hours, a job, but that's all it is. Now, I can say with some authority stick it out, it will be a vastly better existence than almost anyone in nearly any other field.

As for residency you have 2 choices, chase an interest or a lifestyle (if you have the board scores). IM is safe, work after or specialize, or work then specialize.

Just because we rotate with miserable human beings (students and preceptors) doesn't mean we have to live in misery. Stay the course, work 10 shifts, work 20, hell work part-time if you want to. You can change your mind anytime you want, there aren't many other professions where that's the case.

Just do me one favor, don't let immaturity and inexperience convince you you've made a mistake, you haven't, there are 50,000 kids lurking the pre-med forums for a reason.

 

[mk536]

I am not in your shoes by any means (haven't even started M1), but my dermatologist was never particularly interested in medicine (went into it for the stability) and enjoys an academic side career in an artistic field. I have no idea how many hours he devotes to each pursuit, but I don't believe he spends more than 40 hrs/week on medicine, and he may spend significantly less, and I also know he publishes regularly for his side career. So for what it's worth I do know an n=1 of an MD successfully pursuing disparate careers simultaneously. I believe that he completed his residency and paid off loans before seriously pursuing his non-medicine career.

 

[LebronManning]

If you don't do residency you're going to regret it deeply when you're 40 years old barely making enough money to pay mortgage and not being able to pay your kids' tuition especially when you remember you could've just done an easy FM residency and have made 250k for the last 15 years

 

[AABB999]

It is comparatively short and honestly if you are a nerd who is interested in people’s stories (I wager you are) you can really enjoy it or at the very least tolerate it. Not sure what aspects of your experience in clerkship you didn’t like, maybe I could advise more if I did know.

Lemme put it this way: on one sub-rotation (general hospitalist on neuro floor) I followed a new, older admit who had an unusual neuro presentation. I rounded on them twice a day and focused on cheering them up while we did a workup. Diagnosis: metastasis of a previously-undiagnosed, highly-aggressive cancer to the brain. My attending decided I should break the news to them (with the whole team there to jump in if needed). I was terrified at first, but carefully explaining things, comforting them, and rounding on them for the rest of my rotation, as well as discussing with attending the management of a patient (pain meds, palliative radiation, etc) who was stable enough to be discharged to an impending death, was one of the most rewarding experienced I had in medical school.

The other 98% of IM was hours of table rounding, trending lab values, consulting specialists for almost any change in care, and spending 90 seconds actually seeing patients, most of which time was spent shushing them so 6 people could listen to their breath sounds. Outpatient was 95% recommending smoking cessation and better diabetes management to people interested in neither.

I know no field is perfect, and no single rotation (or, for me, several sub-rotations) is representative. But you're exactly right - I'm a nerd who likes people's stories, and I didn't see much of that in my IM time.

 

[deleted103644]

Long story short, I made the decision to go to medical school over pursuing a PhD in my college major (a humanity) because I wanted to impact the lives of more than just the few students who'd take my classes and because I was intimidated by the financial/job instability associated with academia in a shrinking humanities field. I took several years of postbacc classes/work, and am a few months away from finishing M3 now. Maybe it's just M3 talking, but I realize now that was probably a mistake, as I miss the humanities and my interest in medicine has waned somewhat. I'm now in my late 20s, and M3 has left with me no concrete answers over what field to pursue and how to form a career in which I can be happy. I don't want to slave though a residency just to become an unhappy attending in my mid-30s. I have done no electives and am still looking into other specialties, but am very apprehensive about the future. I'm a strong student and am doing fine, but am profoundly burned and right now don't really seen a resolution to that down the road.

I want to try to salvage my life into something that makes me happy. I want time to write, and I'd be happy to teach - I really enjoy it and have prior paid experience in it, both at my postbacc institution and at a private company. Medically, I am most interested in ethics, patient decision-making, palliative care/how people deal with debilitation/death, chronic pain, etc, as well as the psyche of medical students/physicians; for example, a more medically-oriented version of something like the Theater of War (you'll have to google, I can't link) would fall into my wheelhouse. I have non-medical interests too, and would love to incorporate those academically if I could get an academic foot in the door.

I realize it'd be imprudent to drop out now, but part of me wonders whether I should apply for residency. With an MD, I think I would enjoy teaching some classes on the above topics to med students (or undergrads) at a university, doing something in medical education policy at a med school, and maybe running a support group - I went into medicine wanting to help people with these issues, and still do. I have no idea whether I could even do that without an academic degree, or how I'd go about getting involved in that.

I also wonder if it'd be better to try a residency in something like PM&R/palliative med (electives in which I will take before application deadline) and try to find part-time (or full-time) work that appeals to me and affords me time to do the above. I realize any residency doesn't really have a ton of free time to work on an academic portfolio, but that might be fulfilling for me. Also, this would make paying off loans a lot easier, and I might end up liking the work. I would be OK with the massive pay cuts associated with part-time/academia. However, another 4+ year commitment is intimidating to me given how the ~8 months of M3 have gone.


I guess I'd appreciate any insight from anyone who had to make a similar decision. I realize this insight would've been best had years ago, but I'd rather think about it now than when it's even more too late. I'll try to find time to find relevant connections at my institution, but would love any advice.

You should definitely complete medical school and at least an internship at this point. That is enough to get a medical license in most states (which is worth something at least, even if you don’t fully use it).

With an internship, you can do medical consulting (check out McKinsey), but with your interests, I would probably go for IM + palliative medicine or ethics.

There are definitely programs out there that would love to have someone with your interests, maybe give you protected time for writing, etc etc.

 

[DocWinter]

Try Neuro if you haven't yet. Some find it very intriguing.

If you don't find a real interest in anything, you are probably best minimizing your length of training and maximizing your potential to branch out and make your work your own. Internal is the way.

 

[Lnsean]

Long story short, I made the decision to go to medical school over pursuing a PhD in my college major (a humanity) because I wanted to impact the lives of more than just the few students who'd take my classes and because I was intimidated by the financial/job instability associated with academia in a shrinking humanities field. I took several years of postbacc classes/work, and am a few months away from finishing M3 now. Maybe it's just M3 talking, but I realize now that was probably a mistake, as I miss the humanities and my interest in medicine has waned somewhat. I'm now in my late 20s, and M3 has left with me no concrete answers over what field to pursue and how to form a career in which I can be happy. I don't want to slave though a residency just to become an unhappy attending in my mid-30s. I have done no electives and am still looking into other specialties, but am very apprehensive about the future. I'm a strong student and am doing fine, but am profoundly burned and right now don't really seen a resolution to that down the road.

I want to try to salvage my life into something that makes me happy. I want time to write, and I'd be happy to teach - I really enjoy it and have prior paid experience in it, both at my postbacc institution and at a private company. Medically, I am most interested in ethics, patient decision-making, palliative care/how people deal with debilitation/death, chronic pain, etc, as well as the psyche of medical students/physicians; for example, a more medically-oriented version of something like the Theater of War (you'll have to google, I can't link) would fall into my wheelhouse. I have non-medical interests too, and would love to incorporate those academically if I could get an academic foot in the door.

I realize it'd be imprudent to drop out now, but part of me wonders whether I should apply for residency. With an MD, I think I would enjoy teaching some classes on the above topics to med students (or undergrads) at a university, doing something in medical education policy at a med school, and maybe running a support group - I went into medicine wanting to help people with these issues, and still do. I have no idea whether I could even do that without an academic degree, or how I'd go about getting involved in that.

I also wonder if it'd be better to try a residency in something like PM&R/palliative med (electives in which I will take before application deadline) and try to find part-time (or full-time) work that appeals to me and affords me time to do the above. I realize any residency doesn't really have a ton of free time to work on an academic portfolio, but that might be fulfilling for me. Also, this would make paying off loans a lot easier, and I might end up liking the work. I would be OK with the massive pay cuts associated with part-time/academia. However, another 4+ year commitment is intimidating to me given how the ~8 months of M3 have gone.


I guess I'd appreciate any insight from anyone who had to make a similar decision. I realize this insight would've been best had years ago, but I'd rather think about it now than when it's even more too late. I'll try to find time to find relevant connections at my institution, but would love any advice.

You have gone this far...go all the way. Medicine/healthcare has a lot of bs and red tape that many students are not aware of when first starting. I think you are too committed now to venture off. Double down and eventually find an academic position with outpatient hours and a teaching gig.

 

[slurpy15]

Long story short, I made the decision to go to medical school over pursuing a PhD in my college major (a humanity) because I wanted to impact the lives of more than just the few students who'd take my classes and because I was intimidated by the financial/job instability associated with academia in a shrinking humanities field. I took several years of postbacc classes/work, and am a few months away from finishing M3 now. Maybe it's just M3 talking, but I realize now that was probably a mistake, as I miss the humanities and my interest in medicine has waned somewhat. I'm now in my late 20s, and M3 has left with me no concrete answers over what field to pursue and how to form a career in which I can be happy. I don't want to slave though a residency just to become an unhappy attending in my mid-30s. I have done no electives and am still looking into other specialties, but am very apprehensive about the future. I'm a strong student and am doing fine, but am profoundly burned and right now don't really seen a resolution to that down the road.

I want to try to salvage my life into something that makes me happy. I want time to write, and I'd be happy to teach - I really enjoy it and have prior paid experience in it, both at my postbacc institution and at a private company. Medically, I am most interested in ethics, patient decision-making, palliative care/how people deal with debilitation/death, chronic pain, etc, as well as the psyche of medical students/physicians; for example, a more medically-oriented version of something like the Theater of War (you'll have to google, I can't link) would fall into my wheelhouse. I have non-medical interests too, and would love to incorporate those academically if I could get an academic foot in the door.

I realize it'd be imprudent to drop out now, but part of me wonders whether I should apply for residency. With an MD, I think I would enjoy teaching some classes on the above topics to med students (or undergrads) at a university, doing something in medical education policy at a med school, and maybe running a support group - I went into medicine wanting to help people with these issues, and still do. I have no idea whether I could even do that without an academic degree, or how I'd go about getting involved in that.

I also wonder if it'd be better to try a residency in something like PM&R/palliative med (electives in which I will take before application deadline) and try to find part-time (or full-time) work that appeals to me and affords me time to do the above. I realize any residency doesn't really have a ton of free time to work on an academic portfolio, but that might be fulfilling for me. Also, this would make paying off loans a lot easier, and I might end up liking the work. I would be OK with the massive pay cuts associated with part-time/academia. However, another 4+ year commitment is intimidating to me given how the ~8 months of M3 have gone.

I guess I'd appreciate any insight from anyone who had to make a similar decision. I realize this insight would've been best had years ago, but I'd rather think about it now than when it's even more too late. I'll try to find time to find relevant connections at my institution, but would love any advice.

Well...you may as well finish now. Remember, there are NO JOBS for PhDs in the humanities. None. So unless you are independently wealthy, you have to keep going. FWIW, I know a psychiatrist who is a published author. Pick a cush residency like psych or something like EM or Peds where it is easy to do work part time and then look at it as a job and don't worry about it. If you are independently wealthy, then quit now!

 

[ACSurgeon]

Have you considered doing a residency in public health? One year internship (become licensed) and one year doing public health.

If it were me I’d tough out a 3 year IM or EM residency for the financial aspect but to each their own.

 

[siliso]

Sorry your rotation experience was crummy. I am able to have the kind of experiences you describe quite often in Medicine. Consider an icu rotation esp at a tertiary center, and to be fair inpatient high acuity psych. But it sounds like you really like palliative care to which the straightest path is IM and a 1-2 yr fellowship.

But there’s also a great role for a palliative minded person in a lot of medicine from general/hospital to heme onc and critical care.

 

[AABB999]

If it were me I’d tough out a 3 year IM or EM residency for the financial aspect but to each their own.

Thought about it, but like I said, I already feel burned out, and am worried about getting thrashed by shift work when I'm in my 40s-50s. Haven't had my EM rotation yet though.

 

[slurpy15]

Thought about it, but like I said, I already feel burned out, and am worried about getting thrashed by shift work when I'm in my 40s-50s. Haven't had my EM rotation yet though.

Psych? Occ med? Public health? If you don't want to work as a clinician at all, then your residency doesn't matter- just do something short and fast. If you think you might like practicing medicine, different issue. If you want something nonclinical, then public health/prev med residency.

 

[AABB999]

I am able to have the kind of experiences you describe quite often in Medicine.

Do you mind sharing what you do? Hospitalist?

If you think you might like practicing medicine, different issue.

That's the crux of my issue: I do think I might like practicing medicine; I'm just much less sure at this point than I was over the years getting to this point. I certainly don't like M3, which is the best indication of medicine I've gotten at this point.

 

[siliso]

I do inpatient and outpatient general medicine in an academic center, and teach students and residents there. Non academic hospitalist gigs can be so much volume that you don’t have time to do the kind of thing you want to do (and have to call consults for everything).

I bet you would dig the ICU. Many opportunities for critical communications and decision making, can be fast paced but also a fair amount of downtime for thinking/reading/drinking your coffee. Depending on the setting obviously. I didn’t think I’d do medicine until my June 4th yr ICU sub I, and it’s absolutely the right thing for me,

 

[slurpy15]

If you are unsure, there's no harm (aside from financially) with extending to five years to do a few electives. If you feel you haven't found your niche after that, do something general like IM or Peds so you can have a ton of flexibility. Does your school have a malignant third year? I loved my third year (more fun being a student than an attending, I guess).

 

[AABB999]

If you are unsure, there's no harm (aside from financially) with extending to five years to do a few electives. If you feel you haven't found your niche after that, do something general like IM or Peds so you can have a ton of flexibility. Does your school have a malignant third year? I loved my third year (more fun being a student than an attending, I guess).

Not sure how to answer that. M3 has mostly been apathetic attendings and miserable residents, but my impression is that's the case at most med schools. M3 just feels like a job anyone could do to me - clock in, give presentations while the team zones out, do scut work, clock out.

I initially focused on what I talked about above: learning how the patient feels, determining what the patient wants in their care, trying to build rapport, and documenting it all in really solid notes. But few I've worked with in medicine seems to really care about that - few attendings, and even fewer of my peers. I say I miss the humanities because they seem distant in medicine, replaced by numbers, "moving the meat," checking boxes with rudimentary physical exams, and norco/dilaudid PRN.

So I instead focused on what M3 wants from students and have collected a bunch of great evaluations I don't really care about, talking about how good my presentations are and the depth of my "fund of knowledge," whatever that means; I'm more proud when preceptors note my bedside manner and kindness. I am a fairly strong applicant and can probably match in most specialties, but I am much more proud of my undergraduate papers, research, and accomplishments, even though they mean nothing to anyone I've met in medical school or to my presumptive future career. The few people I've talked to about my undergrad thesis - partially on the human experience of illness/death - have rewarded me with blank stares and a quick subject change.

That's my mindset heading into M4. In some ways, I'm the ideal medical student from the ethics lectures we all get in preclinicals. I want to help the patient as a whole, body and mind; the proverbial pediatrician who cured us of our fear of the doctor, or the oncologist who eased grandma's passing for her and for her family. I want to work to keep students and physicians from becoming jaded (or worse), and to help patients view the physician as a trusted ally, someone who has the time to spend talking to them and assuaging their concerns. I want to be like the doctors I shadowed years ago, guiding patients or their families out of the darkness of illness and death, regardless of the clinical outcome.

That also all now seems so profoundly naive and idealistic to me, so unattainable, that I'm left in my current situation: years of 80+ hours a week yoked to a pager, followed by a monotony of prescriptions, lab value regression, and notes written for the benefit of no one but a hypothetical lawyer; or, alternatively, something else entirely.

So thus, my predicament. I've worked for years to get where I am and have thus far been emotionally paid in pyrite. I don't really want my eventual reward to be a fancy car, a prozac prescription, and little else; at this point, though, I don't really know what else to do.

 

[siliso]

You will be a great physician. I’m sorry you’ve had such bad experiences in training. I don’t think that is universal, I’ve been fortunate to work with great teams and enthusiastic teachers (not always, but enough). I hope you can find some clinical instructors to look up to and mentor you in the coming year, and find your people in medicine. They’re out there.

PS I never broke 80 hrs in residency ever, maxed out in the 70s on a couple night float weeks.

 

[Poit]

I would def. stay the course and get your MD and residency. One of the great things about this career is that you're not limited in what you can do (to an extent). Like an above poster mentioned, there are opportunities to branch into the humanities (good medicine cannot be practiced without them). Go into academia and do research to bridge the gap between the softer and harder sciences. At the very least, having an MD and residency will give you the financial leverage and academic clout to do this or other things that you want to pursue. Also, yes, the phD job market for the humanites is abysmal.

 

[L. Beethoven]

I was reading your comments, and I'd say not all is lost. It sounds like one of the major concerns you have is not being able to pursue your passion, and having a long 80+ hour working schedule for Residency. I think you should really look into Psychiatry or PM&R and/or palliative care. There are plenty of programs that can offer a 45-50 hour work week for much of your residency, often with home call. And then as an Attending, you can keep the same schedule or even work half-time, and still make over 100k per year, giving you plenty of time and flexibility (and funds) to pursue any interests you can dream of. While also being in a specialty that prides itself on patient-centered care.

Here's an example - University of Washington Psychiatry - the Residents cite an average of 45 hrs/ week in residency.
University of Washington Psychiatry Residency Training Program

Anyway, I think with reading what you wrote above about caring for patients, one day you're going to be a great doctor. I wish you all the best!

 

[Osminog]

Had you chosen to get a PhD in the humanities, you'd be sitting around grading stupid kids' BSed papers and regretting not going to medical school.

 

[AABB999]

I hope you can find some clinical instructors to look up to and mentor you in the coming year, and find your people in medicine. They’re out there.

Hope so. That's one thing I've missed in my medical education - a mentor I admire and aspire to be like, and someone who cares about me more than whether or not I get their pimping questions right or how well I can suture.

I think you should really look into Psychiatry

My line of thinking really took with my psych rotation. I liked psych, but all of residents I met went into psych for the lifestyle or because they couldn't match anything else. PD was one of my attendings and actually told me the thing they liked about psych was the lifestyle. The second an attending left the observation room in observed clinic, the residents pulled out their phones and talked about their weekends; I was more interested in the interviews than they were. The resident I was assigned to was a nice, cool person, but everything they had to say about psychiatry eventually segwayed into financial planning. There are psych attendings who'd probably write me letters based on their evals, but I would probably consider it more if I were at a different institution.

 

[midi12]

My line of thinking really took with my psych rotation. I liked psych, but all of residents I met went into psych for the lifestyle or because they couldn't match anything else. PD was one of my attendings and actually told me the thing they liked about psych was the lifestyle. The second an attending left the observation room in observed clinic, the residents pulled out their phones and talked about their weekends; I was more interested in the interviews than they were. The resident I was assigned to was a nice, cool person, but everything they had to say about psychiatry eventually segwayed into financial planning. There are psych attendings who'd probably write me letters based on their evals, but I would probably consider it more if I were at a different institution.

It's what you make of it... certainly there are plenty of boneheaded people in psych, but some are brilliant. I had one attending whose progress notes read like beautifully crafted narrative essays that were able to completely describe a persons being with pinpoint precision. Not just MSIGECAPS. Mind blowing stuff in the world of medicine. Certainly someone with a humanities background has the potential to be one of the greats in that field.

 

[StackOfTurtles]

Hello, friend. I found your post when I searched "Humanities PhD" because my problem is the mirror image of yours. I'm 30 and in my 5th year of my PhD in a humanities discipline. Three years in, I decided that academia wasn't the utopia I thought it was, and if I have to deal with BS, I'd like to feel like I'm making a material difference in people's lives, and I'd like to get paid -- so I started on post baccalaureate prereqs and I'll take my MCAT in June.

Osminog is spot on: I am tired of reading papers that students complete in the pursuit of points rather than knowledge, and I regret not going to med school. There are some really fantastic students who make teaching worthwhile, but a lot of academia can be pretty exploitive. Grads provide cheap teaching labor, but the job prospects for humanities PhDs are caca (Thomas Benton's (in)famous "Graduate School in the Humanities: Just Don't Go" is worth chewing on). You can bust your buns to do great research, but you won't get paid when it's published: the academic publishers profit and you get a line on your CV. You'll get a lot of rejections and revise and resubmits first, though.

Moreover, humanities research is usually single-authored and so the research process is ascetic. This is great for some folks, but I find it draining -- not to mention that my dissertation is on a topic so narrow that my committee will probably be the only people who ever read it.

A PhD in the humanities has some nice features: you have a lot of autonomy to structure how and when you work, and the challenge of lifelong learning can be very rewarding. You don't "work" summers, but don't kid yourself - you're expected to be very productive at all times, because the performance of perpetual business is a cult in the academy.

I wish I could say that this is just my perspective, but this kind of cynicism is widespread among humanities PhDs, and rates of depression are quite high. Moreover, if you are interested in the humanities, I'm told that's desirable in a physician -- plus, there are a lot of ways to scratch the humanistic itch without making it your (low-paid) career. I can't tell you what's right for you, of course. You might be a humanities research rockstar, and you might find intrinsic value in the research process that I don't -- but this is the stuff I wish someone told me before I started, and if it helps you the past five years will not have been in vain 🙂

 

[deleted866694]

I relate to a lot of what you said, OP, and would second the recommendation of psychiatry. I met many people you'd find interesting and like-minded on the interview trail, at places like Cornell, Stanford, and Cambridge Health Alliance.

Check out Falling into the Fire by Christine Montross, a psychiatrist and a beautiful storyteller. Also try James Gilligan's Violence: Our Deadly Epidemic, a great example of a nuanced study of the human condition that's informed by decades of clinical experience.

I'd also echo the suggestion of a fifth year - sounds like you could use some time to find mentors (in multiple specialties); recover from burnout; do away electives (in ethics and/or at better psych departments); and then tailor your applications to whatever you end up choosing.

Good luck!

 

[AABB999]

three years in, I decided that academia wasn't the utopia I thought it was, and if I have to deal with BS, I'd like to feel like I'm making a material difference in people's lives, and I'd like to get paid -- so I started on post baccalaureate prereqs and I'll take my MCAT in June.

Thanks for the advice, and good luck. If it counts for anything, I have found medical school to overall be much easier than serious/rigorous humanities academic work. I was more challenged during my junior/senior years of undergrad than at any point since; hopefully you experience the same.

I guess the grass is always greener...my initial decision was driven by a lot of what you talk about (watching brilliant people bounce between jobs, desperate for tenure; editing non-majors' horrific writing, which made my brain ache; and the unfortunate knowledge that I may never get tenure, and even if, few would ever read my papers on my esoteric research foci) but I do miss aspects of creativity and the intellectual "asceticism" you mention.

I met many people you'd find interesting and like-minded on the interview trail, at places like Cornell, Stanford, and Cambridge Health Alliance.

I believe you, but I doubt top programs are interested in late-comers to the field like I would be. I am apprehensive about a 5th year simply because I don't really want to add the equivalent of another fairly nice car to the already-packed garage of my student loans, or another year to my tenure in unhappiness...I guess dual applying is always an option, albeit a poor one.

 

[SooDeeO]

Hope so. That's one thing I've missed in my medical education - a mentor I admire and aspire to be like, and someone who cares about me more than whether or not I get their pimping questions right or how well I can suture.




My line of thinking really took with my psych rotation. I liked psych, but all of residents I met went into psych for the lifestyle or because they couldn't match anything else. PD was one of my attendings and actually told me the thing they liked about psych was the lifestyle. The second an attending left the observation room in observed clinic, the residents pulled out their phones and talked about their weekends; I was more interested in the interviews than they were. The resident I was assigned to was a nice, cool person, but everything they had to say about psychiatry eventually segwayed into financial planning. There are psych attendings who'd probably write me letters based on their evals, but I would probably consider it more if I were at a different institution.

It sounds like you view that the more time spent with patients, the more profound patient care you delivered; and you also feel most rewarded from these patient interactions. There are certain specialties that are better suited to provide such opportunities, such as psychiatry as previously mentioned. Critical care also involves a lot of end-of-life discussions and aids in complex decision making processes for the patients and family (most often, people pursue IM residency and pulm crit fellowship afterwards for ICU privileges. Could also do anesthesia and critical care. Could also finish general surgery and critical care fellowship afterwards but I wouldn't recommend this route if your primary concern is lack of time spent with the patients.)

I wouldn't be discouraged by the impression you got from your psych residents/attendings, if you liked the specialty.
One of the most brilliant classmates of mine from med school went into psychiatry, even though he could have matched into any specialty of his choosing. He had a neuroscience/linguistic background, and psychiatric pathophysiology fascinated him. His wife is also an inpatient psych social worker, the couple had a vested interest/passion in this patient population.
So not all go into psychiatry because they couldn't match into other specialties or because of the lifestyle. Perhaps, if you find a competitive psych program, people you work with are more likely to be in that specialty because it's what they desired, not what they settled with.

It sounds like you have had a discouraging bunch of residents/attendings who may not have put the best effort in teaching medical students. (admittedly, when things get busy, I'm sometimes guilty of it, too) However, you also mentioned that one of the attendings went out of his/her way to teach you how to convey the bad news to the patient/family, which was not only a clinically important skill to mater but also an extremely rewarding experience for you as an (hopefully still) aspiring physician. Not all physicians/residents are jaded, and some are better at devoting to resident/medical student teaching than others; you experienced both types in your training so far. And remember, you can be that teaching attending and make a difference in your trainees' learning experiences if you choose an academic career in medicine.

Oh by the way, I also think PM&R may be a good match for you, too. For instance, severe burn patients suffer a prolonged hospital course (a patient of mine stayed in the hospital for ~450 days) from repeated excisions and skin grafting/sepsis/multiple ICU stays, and the PM&R service is integral to the patients' recovery both while in the ICU and in the inpatient rehab after discharge. Even when they are finally healthy enough to be home, these patients then deal with contracture and revisional operations for the remainder of their lives; so they are followed by PM&R physicians in the outpatient setting, and you build a life-long relationship with these patients. Frequently, most burn patients deal with extensive psychosocial issues that led them to the burn accidents/suicidal attempts to begin with as well as after the burn trauma itself. Witnessing the progress these patients make over the course of their lifetime can be extremely rewarding, and this might just be your cup of tea.

 

[deleted866694]

Your point about the fifth year is totally fair.

Regarding top psych programs: most programs will understand that students have to make career choices toward the end of clerkship year, whether because their psych clerkship is in the spring or because they realized late in the year that their previous specialty choice was no longer right for them. I myself switched to psych in late April and, although my application had many flaws, my "late" interest in psych was never mentioned as one of them...

 

[IM-2019]

With an MD, I think I would enjoy teaching some classes on the above topics to med students (or undergrads) at a university, doing something in medical education policy at a med school, and maybe running a support group - I went into medicine wanting to help people with these issues, and still do. I have no idea whether I could even do that without an academic degree, or how I'd go about getting involved in that.

We have a few ethics/humanities electives for M4 that are run by a handful of physicians with all different degrees: MD only, JD/MBA, PhD, and a psychiatrist teaches the pre-clinical behavioral health and ethics classes.

Psychiatry can also do the palliative care fellowship, though I'm not sure how common that is. There's also Clinical Genetics, which involves a mixture of counselling and a lot of ethics opportunities, but focused in a specific field.

If you wanted formal training, you could probably do a 1 year MPH with a concentration in ethics or a fellowship with an MPH included and look for academic jobs where teaching would be possible. I'm not quite sure what that career would look like, but you could reach out to faculty at your school about it.