M3 super unsure about specialty choices.

[nguyening2020]

Hey everyone,
I'm an M3 still undecided on a specialty. So far I've completed, I've really enjoyed all of my rotations, but I've ruled out FM, peds, and IM.

Mid-tier med school. Average student but only 223 on Step 1. Pass all my rotations so far. I also have 1 random research in med school and 2 during undergrads. Might publish a case report soon.

Initially, I was thinking EM but with the job market, it’s not super idea for me anymore. but I've been on my surgery rotation for the past 6 weeks and have really enjoyed using my hands and my residents have really been pushing me towards surgery; but also I don’t enjoy the sometimes long procedure and was wondering if anesthesia might be better.

Things that are important to me:
- Short residency/fellowship time: I'm eager to get past 80 hour weeks and horrible schedules
- Good work-life balance with a flexible schedule, ability to take 3-4 day weekends, or take a couple of weeks off at a time for traveling, shift work would be nice
- I don't need to go into the highest paying specialty, but I want to feel adequately compensated.
- I don’t want to be in a field that won't soon be oversaturated. I don't want to do research, but I would enjoy teaching.
- Ability to use my hands (procedures) and my mind (thinking through pathophysiology/pharmacology)

I would love to hear some suggestions based on my 'wish-list' above, of course I know I’m not competitive for gen surg but I’m not trying to go anywhere competitive.

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[flapjack3d]

PM&R. lots of short procedures, lot of thinking through biomechanics and problem solving. probably one of the best stress:compensation ratios in medicine besides derm imo. with some of the more experimental injections (prp, etc) the sky's the limit for compensation if you can find the market. best work-life balance in residency of any specialty (besides psych), except at a few outlier workhorse programs. not a lot of opportunity for shift-work though. all the pmr attendings i know are happy and take a lot of time for vacation and side projects.

 

[Ganon]

Hey everyone,
I'm an M3 still undecided on a specialty. So far I've completed, I've really enjoyed all of my rotations, but I've ruled out FM, peds, and IM.

Mid-tier med school. Average student but only 223 on Step 1. Pass all my rotations so far. I also have 1 random research in med school and 2 during undergrads. Might publish a case report soon.

Initially, I was thinking EM but with the job market, it’s not super idea for me anymore. but I've been on my surgery rotation for the past 6 weeks and have really enjoyed using my hands and my residents have really been pushing me towards surgery; but also I don’t enjoy the sometimes long procedure and was wondering if anesthesia might be better.

Things that are important to me:
- Short residency/fellowship time: I'm eager to get past 80 hour weeks and horrible schedules
- Good work-life balance with a flexible schedule, ability to take 3-4 day weekends, or take a couple of weeks off at a time for traveling, shift work would be nice
- I don't need to go into the highest paying specialty, but I want to feel adequately compensated.
- I don’t want to be in a field that won't soon be oversaturated. I don't want to do research, but I would enjoy teaching.
- Ability to use my hands (procedures) and my mind (thinking through pathophysiology/pharmacology)

I would love to hear some suggestions based on my 'wish-list' above, of course I know I’m not competitive for gen surg but I’m not trying to go anywhere competitive.

This sounds like anesthesia?

I'm no expert, but that's my impression

 

[mrbreakfast]

Based on your criteria, I can give you 3 recommendations, each of which is a 4 year residency that isn't too competitive; however, each comes with one compromise:

1) Neurology -> neurohospitalist. Meets every criteria to a T, with the exception of procedures (though you do rely on a physical exam)
2) Anesthesia. Only compromise is saturation (encroachment from CRNAs) though I don't know if that's actually a big issue
3) OBGYN. Main compromise is scheduling - residency is brutal, and unless you do a fellowship, I think you're inevitably going to be catching some babies at 3 am.

You can look into PM&R, but if you were initially interested in EM and surgery, I think you probably won't like it.

 

[nguyening2020]

Based on your criteria, I can give you 3 recommendations, each of which is a 4 year residency that isn't too competitive; however, each comes with one compromise:

1) Neurology -> neurohospitalist. Meets every criteria to a T, with the exception of procedures (though you do rely on a physical exam)
2) Anesthesia. Only compromise is saturation (encroachment from CRNAs) though I don't know if that's actually a big issue
3) OBGYN. Main compromise is scheduling - residency is brutal, and unless you do a fellowship, I think you're inevitably going to be catching some babies at 3 am.

You can look into PM&R, but if you were initially interested in EM and surgery, I think you probably won't like it.

How much of a problem do you think the encroachment from CRNA is? Because now there’s also AAs and it’s just seems like a lot of people trying to get a piece of the cake.

 

[nguyening2020]

Based on your criteria, I can give you 3 recommendations, each of which is a 4 year residency that isn't too competitive; however, each comes with one compromise:

1) Neurology -> neurohospitalist. Meets every criteria to a T, with the exception of procedures (though you do rely on a physical exam)
2) Anesthesia. Only compromise is saturation (encroachment from CRNAs) though I don't know if that's actually a big issue
3) OBGYN. Main compromise is scheduling - residency is brutal, and unless you do a fellowship, I think you're inevitably going to be catching some babies at 3 am.

You can look into PM&R, but if you were initially interested in EM and surgery, I think you probably won't like it.

Thanks! I did thought about neuro but I hate the feeling of you’re not really doing much for them beside delaying the process. I love OBGYN actually but the toxicity of my home program has really deter me from it as I heard the rest of the field isn’t much better…..

 

[nguyening2020]

PM&R. lots of short procedures, lot of thinking through biomechanics and problem solving. probably one of the best stress:compensation ratios in medicine besides derm imo. with some of the more experimental injections (prp, etc) the sky's the limit for compensation if you can find the market. best work-life balance in residency of any specialty (besides psych), except at a few outlier workhorse programs. not a lot of opportunity for shift-work though. all the pmr attendings i know are happy and take a lot of time for vacation and side projects.

Do you think it’s feasible to match now? I’m almost at the end of my M3 and I heard for PM&R, you have to be interested in the beginning.

 

[Redpancreas]

I think the issue seems to be that you’re ruling out good fields for bad reasons (i.e. neurology because you just delay a process). It’s important to keep an open mind.

PM&R is feasible to match now. Just do an early elective before you apply.

I would look at the big picture instead of things you hear of think of stereotypically as a student.

 

[flapjack3d]

Do you think it’s feasible to match now? I’m almost at the end of my M3 and I heard for PM&R, you have to be interested in the beginning.

Definitely feasible. Most people don’t know about pmr until third year

 

[IMGASMD]

CRNAs have been there for a long time. It’s the same doom and gloom for years now. But there are still plenty of people who are still in the speciality.

- I work with my hands every day, unless I am supervising. I am probably on supervision duty once a week. It’s really practice and location dependent.
- I use my physiology, pathophysiology, and pharmacology knowledge on a daily basis.
- I get instant gratifications daily. Sometime it’s as simple as I got my sickest patient through a tough surgery.
- I like my quick interactions with patients. If I like them, great. If I don’t like them, I won’t have to deal with them again.
- I think I get paid decently. I won’t be a multi-millionaire, but certainly won’t starve.

Onto the negatives
- CRNAs (it may not be as much of an issue during your training). I just don’t like to deal with them or the interpersonal conflicts.
- training is four years. During residency, we were Q4-6. I thought it was fine, and you really learned the most when you’re under some stress. More you see, more you…. see. But you may think that’s too much.
- just like every other speciality…. It’s based on local supply and demand. If you want to live in a big city, your income will suffer.
- just like EM and other industries, including hospital systems, a lot of consolidations around; (however, still plenty of private groups around.)
- you get zero glory and all the blames. Just walk into any ORs, scream “it’s all anesthesia’s fault.” See how many chuckles you will get. Patients, even staffs, will all praise the surgeon; no one will think twice that you just “suspended death” for the duration of the surgery, and woke them up, because it is expected in our work. That they wake up at the end.

You need to do a rotation for all these specialities, just because it looks good on paper, doesn’t mean anything unless you’ve done it. While you’re on rotation, see if your attendings are who you want to be. Are they happy? Are they miserable? Do they have the same sense of humor that you do. Are you interested in the similar things? Don’t compare with residents, they are only there transiently. The attendings are the people you want to grow up to be. The stereotype for specialities exist, because they are mostly true. If you enjoy being with them, more than likely you are similar more than different.

Spend some time in different forums here may get you some ideas too. Anesthesia is just a much better fit for me….. don’t think I can be doing anything else.

Good luck.

 

[mrbreakfast]

Thanks! I did thought about neuro but I hate the feeling of you’re not really doing much for them beside delaying the process.

I've tried many times on these forums to convince med students that their thinking is wrong about neurology - many more neurological diseases are treatable than you think, neurology as a specialty has better outcomes than many other specialties, new developments are coming out constantly in the field - but don't think I've successfully convinced anyone yet.

A neurohospitalist is an inpatient consultant who only deals with acute neurological issues. Strokes, seizures, GBS, etc. Much/most of the time is spent in the ED, as if anyone walks into the ED with an even vaguely neurological issue (new-onset weakness/sensory loss, dizziness, loss of consciousness, acting weird, loss of vision, whatever) you're seeing them. You see emergencies, like acute strokes or status epilepticus. You also see routine stuff, like altered mental status, and depressing stuff (brainstem IPH, punched/shot in the head, hangings/anoxic injuries, CO poisoning, etc) but you're pretty much the only person in the hospital who knows anything about neurology, so lots of people want your help. In the community setting, it's 100% consultant work (no primary patients). You see many patients just once, sometimes just for a few minutes. It's a fast-paced job that is similar in many ways to EM, except with the opposite job market.

You end up seeing a lot of people who are going to have a bad outcome unless you do something, and also see a lot of people who are going to have a bad outcome regardless of what you do. If that's not your cup of tea, no worries. But I would at least consider it. See if you can't spend a day shadowing a neurohospitalist at a bigger community hospital nearby. You might be surprised.

 

[SpinDrift]

I've tried many times on these forums to convince med students that their thinking is wrong about neurology - many more neurological diseases are treatable than you think, neurology as a specialty has better outcomes than many other specialties, new developments are coming out constantly in the field - but don't think I've successfully convinced anyone yet.

A neurohospitalist is an inpatient consultant who only deals with acute neurological issues. Strokes, seizures, GBS, etc. Much/most of the time is spent in the ED, as if anyone walks into the ED with an even vaguely neurological issue (new-onset weakness/sensory loss, dizziness, loss of consciousness, acting weird, loss of vision, whatever) you're seeing them. You see emergencies, like acute strokes or status epilepticus. You also see routine stuff, like altered mental status, and depressing stuff (brainstem IPH, punched/shot in the head, hangings/anoxic injuries, CO poisoning, etc) but you're pretty much the only person in the hospital who knows anything about neurology, so lots of people want your help. In the community setting, it's 100% consultant work (no primary patients). You see many patients just once, sometimes just for a few minutes. It's a fast-paced job that is similar in many ways to EM, except with the opposite job market.

You end up seeing a lot of people who are going to have a bad outcome unless you do something, and also see a lot of people who are going to have a bad outcome regardless of what you do. If that's not your cup of tea, no worries. But I would at least consider it. See if you can't spend a day shadowing a neurohospitalist at a bigger community hospital nearby. You might be surprised.

Not to mention the interventional aspects of neurology.