MD MS3 Need advice on choosing specialties!

[oatmealraisin99]

Hi there! I'm a MS3 at a mid-tier med school and am still so undecided on what specialty to do. 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... Medicine just seems like a pretty practical field. Also a lot of residencies in CA.
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 "people" people, laidback, and smart). 1 year fellowships! Good pay.
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 at a Kaiser hospital). Not being viewed as someones "doctor" or getting much credit. 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. At my hospital, there were a lot of MD/pHD's or foreign graduates and while they were all awesome I just 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 i feel like 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 )!!

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[JacobAllan]

Based on the essay above, I would say you are leaning towards IM. Even though it does have its disadvantages? If you really don't like it after a few years maybe with the time off they allow you, you can give something else a try? I don't know just my view on it. Whatever you decide best of luck!

 

[longhaul3]

You don't have to do research to get into or practice in neurology. It's one of the least competitive fields in medicine. The upside is that you can have multiple daily conferences with catered food and still leave the hospital by 4. The main downside is that it's boring as hell.

It is true that non-neuro physicians know shockingly little about neuro. It's pretty scary to me.

 

[IMGASMD]

Do you like OR? You haven’t done anesthesia elective and you’re considering it? Pretty big no no, right?

 

[oatmealraisin99]

Do you like OR? You haven’t done anesthesia elective and you’re considering it? Pretty big no no, right?

After doing my surgery rotation, I realized I did like the OR! I just didn't like the standing or surgery culture... That's actually why I started considering Anesthesia more seriously. And I thought the same, but realized that not many MS3's do an anesthesia elective during the 3rd year, yet they still decide they want to do it (same going with other specialties that are the "core" rotations).

 

[IMGASMD]

After doing my surgery rotation, I realized I did like the OR! I just didn't like the standing or surgery culture... That's actually why I started considering Anesthesia more seriously. And I thought the same, but realized that not many MS3's do an anesthesia elective during the 3rd year, yet they still decide they want to do it (same going with other specialties that are the "core" rotations).

I would not advise you choose your future 30 years based on observation while you were life-hating MS3 holding camera. You need to do at least one rotation.... make time, switch your elective, curve time from your surgical rotation.

 

[oatmealraisin99]

I would not advise you choose your future 30 years based on observation while you were life-hating MS3 holding camera. You need to do at least one rotation.... make time, switch your elective, curve time from your surgical rotation.

I agree completely! The reason i'm asking for advice now is because we're selecting our schedules for MS4 year. I definitely will try to get the Anesthesia elective for 4th year (and if I hate it there is still some time to switch out), but am at least trying to narrow my options down to 2 specialties so that I can optimize MS4 year planning. No hope in getting the elective this year (i tried) but will have some opportunities to shadow which I will definitely do.

 

[IMGASMD]

IM - inpatient/outpatient very different worlds. Some people get stuck in one or the other. Some people like one or the other. Some do enjoy doing both, but maybe a little harder, nowadays. Lots opportunities to specialize, but you need to sort of love at least the idea of being an general internist if you don’t get into high paying sub speciality. You can do a lot as an internist.
What you described is what you saw in the inpatient service. Outpatient you get to do much focused management. You typically have 30 mins or less for a visit. You can only address one or two problems. But you do get to know your patient on a much more personal level than at the hospital when they needed more acute care. Some of those interactions may remind you why you wanted to do medicine in the first place.

Anes - you’re always playing second fiddle. You have to be okay with it. There are plenty of threads addressing this, just search. Interactions are brief. At end of the day there is a sense of self satisfaction, if you didn’t cause m/m on someone.... (joking but really not). No patients will ever come to you and say thank you. To them you’re were merely doing your job, to put them to sleep and wake them up at end of the case. You’re the “doctor” in the room. Again no one cares, until something bad happens. Higher stress. Even just pushing propfol, when you push it a couple thousand times year, there bound to be one or two that make the anal sphincter tightened.

There are “personalities” for each speciality for a reason. So you need to decide and look deep within.

Good luck.

 

[allantois]

How about EM - hospital environment, generalist, procedures, but you don’t have to manage ALL patient’s problems

 

[Mass Effect]

Sounds to me like you would enjoy IM with a fellowship so you wouldn't have to be a generalist, but still have the knowledge and ability to do so if needed. Cards? Endocrine? Rheum? GI? Allergy? See what you gravitate towards in residency.