Medical MS3 can't decide on specialty and am panicking! What should I choose between IM vs Anesthesia vs Neurology?

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Oct 27, 2013
Hi there! I'm a MS3 at a mid-tier medical school in Ca and have to decide my 4th year schedule in a few weeks. I'm very much undecided on what specialty to do and have been very stressed about this. Will take any and all advice! My top three choices are IM, Anesthesia, Neurology in no specific order.

I definitely want to stay in california for residency and am not looking at super competitive specialties for a multitude of reasons. I have an okay step score but no significant research.

Things I like about IM: I liked the rotation, the idea that I can work as a hospitalist while I'm young and transition to clinic when I'm older and have a family. I like the idea of 7 days on and 7 days off. I didn't HATE rounding (don't know if loved it...) but liked being able to discuss management. I loved the residents that I worked with and enjoyed the personalities of people in IM. Also its the field people tell me to pick when I can't decide...
What I didn't like about IM: I'm not sure I enjoyed having to manage ALL of the patient's medical problems and being a generalist. I think the idea of being a specialist in a certain field appeals to me more. Did not like having to do things like track creatinine daily and focus on little things, did not like the dispo challenges involved and would rather be able to sign off on a patient once their medical issue is managed.

Things I like about Anesthesia: (Was not able to do an elective, so this is just speculation/what I've heard) I liked the idea of procedures and being able to be in the OR without having to do surgery (and also being able to sit). Not taking home your work, and being able to "check off" the tasks that you do in a day. I liked the 15 minutes that they spend with their patients comforting them and preparing them for anesthesia. I like the short but personable interactions. I liked that I'm there for the patients when they wake up. I liked the people (generally the residents and attendings seem like they are outgoing, laidback, and smart). 1 year fellowships!
Don't know if I like: the option of not being able to do clinic at some later point in life, viewed as a "service" to the surgeons, shift work, the ??? about future of CRNA's and workload at certain hospitals. (would like to be able to take vacation/ be with my family when need to - and a family member who is an anesthesiologist said he only got 1 out of every 4 christmases off). Not being viewed as someones "doctor". No longitudinal care.

Things I like about Neurology: The brain is pretty cool and fascinating. I like the idea of being a specialist in a topic that people aren't very familiar with. I really respected the old neurologists who seemed like they were so knowledgable and wise and wanted to be like them someday. I liked that I could work in both hospital AND clinic environment, and there is supposedly a large demand for neurologists so it would be easier (?) to find a job. My family had a lot of neurodegenerative diseases and no one in medicine to explain things well to them, so they would be happiest if i studied it.
Things I don't like: It can be a REALLY sad field. During my rotation, it was a lot of GBM's, metastatic melanomas, strokes, etc. I get attached to people easily so I'm not sure how well I would fare seeing patients that I get close to having to go through these horrible diseases. Can't really "cure" anyone and are just trying to manage these diseases. Also am not sure how much I would get along with people in the field, they are typically more introverted. At my hospital, there were a lot of MD/pHD's or foreign graduates and did not get along with them as well as I did with the IM residents. On top of that, I don't have much research experience nor do I really want to do research in the future and neurology is a HUGE research field.

Sorry that was long - Not sure if these are all the things I like/dislike about the field but its what I could come up with for now. ANY ADVICE IS APPRECIATED (even if you didnt read the essay above )!!
You should try to set up an elective in anesthesia to give it a fair comparison to the others.

You also need to have a little more focus on the bread and butter cases. Which bread and butter cases can you most easily bare for a 30+ year career?

What are the most important things to you? Is it schedule allowing time with family? Is it "being someones doctor?" Etc.
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