M3 Panicking Between Which Specialty to Apply to (Desperate Need of Help)

[dogssaywoof]

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Hi everyone! M3 here and really struggling with choosing a specialty. I’m hoping to hear from people further along who’ve been in a similar spot.

The biggest thing I’ve learned this year is that I genuinely love the puzzle-solving side of inpatient IM. I enjoy working through complex cases and figuring out what’s actually going on. When a diagnosis clicks or a plan comes together, that feeling is huge for me. I like breadth, complexity, and being the one tying everything together.

But at the same time, on IM I often felt like I was treating patients through a computer screen instead of the person in front of me. A lot of my day felt tucked away in workrooms managing details rather than actively intervening. Even though the work mattered, I sometimes felt removed from the impact, and the days felt long.

In contrast, I really enjoyed surgery because it felt direct and hands-on. Being in the OR or involved in procedures made me feel like I was fixing a problem in real time. I liked the team dynamic, the leadership structure, and the sense of immediacy. At the same time, many of the residents I worked with seemed burned out and warned me about the lifestyle, and I’m not sure I want a career that’s entirely OR-heavy or built around very long cases every day.

Other things I’ve learned about myself:
-I’m a people person and value real patient relationships
-I want variety and don’t want to treat the same narrow problem every day
-I want expertise and ownership in my field
-I like being a leader on a team
-I want a mix of acute care and long-term management
-I’m willing to work hard in training but want a relatively regular schedule long-term

I’ve always pictured myself in something anatomy-heavy. I loved anatomy lab and still get excited seeing anatomy in the OR. I didn’t always love laparoscopic cases, but I honestly don’t know how much of that was the cases vs me being a bored med student standing in the corner, which makes it hard to interpret what I actually like. I’ve seen people describe ICU/critical care as a mix of complex medicine and hands-on intervention, which sounds appealing. The problem is I barely have any ICU exposure yet, so I don’t know if that’s a real fit or me projecting. Right now the fields I keep circling back to are IM/med-peds [as I haven't done peds yet, but neonatal management interests me,] general surgery, and possibly EM. I know my exposure is limited as an M3 and I’m trying to seek electives that will clarify this.

 

[chicandtoughness]

Don’t hate me but… have you thought about obgyn? 😂

 

[HuskyMD Emeritus]

Consider pulmonary-critical care. ICU is like inpatient IM on steroids.
Pulmonary gives you the longitudinal, patient/doctor relationship and since there is clinic, a regular schedule is part of the practice.
Since the lung is involved in a host of systemic illnesses, you will need to know a lot of IM also (such as ID, rheum, hepatology, renal, cards, endo--speaking of endo, you will manage more DKA and adrenal crisis than an endocrinologist when you do ICU call).
Pulm-CCM has lots of procedures also, some almost surgical, such as perc-trachs, PleurX catheter insertions, medical pleuroscopy and interventional bronchoscopy.
While sleep medicine is a separate specialty, it is part of pulmonary fellowship and many pulmonologists are sleep boarded as well. So when you want to have a slow clinic practice and get out of the ICU, you can do sleep (many of my colleagues are quadruple boarded: IM, pulm, CCM and sleep).
I have to admit the burn out rate from doing too much ICU can be high, but after 30+ years of doing pulm-CCM, I still think it is a good specialty and have no regrets.

 

[I'dPitThat]

Don’t hate me but… have you thought about obgyn? 😂

While I was reading this I was like oh that sounds like my specialty lol.

Ob has a good amount of variety, plenty of cool surgeries with interesting anatomy, plenty of medicine, and even puzzle type cases where you are trying to figure out what is going on. The lifestyle kind of sucks as a resident, especially on OB blocks, but life as an attending can be quite nice.

 

[dogssaywoof]

While I was reading this I was like oh that sounds like my specialty lol.

Ob has a good amount of variety, plenty of cool surgeries with interesting anatomy, plenty of medicine, and even puzzle type cases where you are trying to figure out what is going on. The lifestyle kind of sucks as a resident, especially on OB blocks, but life as an attending can be quite nice.

Hi, thanks for the reply! Ob was my first rotation and I did enjoy it! I enjoyed the anatomy and the clinic time. I just wasnt sure if i could be as happy go cheerleader-esce like my attendings were during deliveries. I thought I would like OB more than I think I did. I felt that at times, the clinic was something I enjoyed less. I do want a lasting patient relationship I have come to realize. I guess the OB residents i worked with were in the thick of it (one told me about their regret of not doing GS, and hearing most physicians stop OB and more to clinic was not encouraging. I also do not know if i have a passion for woman's health like some of my classmates applying. I also feel like at this point OB is too competitive for me to seriously consider now.

 

[I'dPitThat]

Hi, thanks for the reply! Ob was my first rotation and I did enjoy it! I enjoyed the anatomy and the clinic time. I just wasnt sure if i could be as happy go cheerleader-esce like my attendings were during deliveries. I thought I would like OB more than I think I did. I felt that at times, the clinic was something I enjoyed less. I do want a lasting patient relationship I have come to realize. I guess the OB residents i worked with were in the thick of it (one told me about their regret of not doing GS, and hearing most physicians stop OB and more to clinic was not encouraging. I also do not know if i have a passion for woman's health like some of my classmates applying. I also feel like at this point OB is too competitive for me to seriously consider now.

Maybe area or program specific. No one I know who has graduated from my program except for the people who went to fellowship are doing anything but full scope obgyn except for one who is a laborist.

I know some former Gen surg residents who are now OB residents. I don't know anyone who wishes they went the other way lol.

Clinic does wear on you. I like my own clinic where I see my patients that I've established a relationship with. Seeing the general acute clinic where you diagnose MAB after MAB is not fun.

I love obstetrics though. Not everyone loves it, and some people do prefer gyn which is also totally fine. So you don't need to be a cheerleader. And for the people who absolutely end up hating it, there is always a gyn only practice or a fellowship. I would take a gyn only practice seeing gyn stuff and doing our surgeries every day and twice on Sunday before being a general surgeon.

 

[operaman]

If you’re worried about being competitive for OB then the surgical subs (ortho, Ophtho, Nsgy, ent, uro) may be out of reach, but the subs do generally check all the boxes you list. General surgery to a fellowship may offer some similar features. IM to a procedural fellowship the same.

 

[collegestud2013]

If this were my advisee and they were genuinely torn, I would tell them to apply Internal Medicine. It preserves maximum future agency.
IM can become:

– Hospitalist with high acuity and procedures
– GI or Cards for anatomy plus procedures
– PCCM for ICU plus hands on plus physiology
– Heme onc for longitudinal relationships
– ID, Rheum, Endo for intellectual depth
– Primary care with leadership and systems work
– Academic research
– Health policy
– Digital health or telemedicine
– Even a second residency if they pivot


Surgery does not give you that kind of optionality. EM has some, but less longitudinal ownership. General surgery locks you in early.

“I want expertise and ownership” plus “I want variety” plus “I want acute and long term” screams Internal Medicine with a procedural fellowship downstream. GI or PCCM are almost custom built for this personality profile.


GI in particular hits:
– Anatomy heavy
– Procedures
– Longitudinal clinic
– Acute bleeds at 2 am
– Complex physiology
– Leadership in care coordination


PCCM hits:
– ICU acuity
– Procedures
– Complex integration
– Team leadership


Even general cardiology would satisfy the anatomy and intervention itch.