Need advice on the process choosing a specialty

[sanfran256]

Hi all,

So I am a rising third year medical student who has no idea what specialty I want to do. I was thinking IM, FM, or EM in second year but truthfully I have not much clinical /shadowing experience in surgical specialties so I guess I shouldn't completely rule those out

Was anyone else in this situation before third year? I am nervous because I know for some specialties , research and other ECs are essentially required in the field

How did you go about deciding what specialty to enter?

I am doing family medicine first when I start back mid-May
I took my Step 1 exam last month and did reasonably well (250) .

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[ndafife]

Figure these two out 1st:
Clinic or Hospital?
Procedures or not?

Then from there its really a feel thing. To quote one of my attendings, "find the orifice that offends you the least"

 

[mimelim]

Most people who didn't know what they wanted to do and were stressed about it spent time with various departments before they started their clinical rotations. Personally, I spent 6 weeks rotating through 6 different departments between MS1 and MS2. It was more of a what am I less interested in than what am I interested in to be honest. Was able to cross some things off the list early on.

 

[DrMcCoyDO]

Figure these two out 1st:
Clinic or Hospital?
Procedures or not?

Then from there its really a feel thing. To quote one of my attendings, "find the orifice that offends you the least

I would add to this, are you interested in longitudinal care or not?

 

[BigRedBeta]

It's really good to think in big, dichotomous boxes like others have suggested.

I personally tell med students to go down the following check list:
Operating Room or No? - definitely the biggest distinction possible and will put you in the right general direction and the culture distinction between that and a more general "procedures" is important in my mind.

Only kids, only adults, only women? If there's a specific patient population that you can rule out that removes a lot of considerations.

Generalist or one organ system - if you like the idea of being generalized then that puts things like EM, FM, or General Medicine or General Peds or even Critical Care or NICU/PICU (in the peds world) towards the forefront compared to being an expert in one organ system. On the surgical side of things, then that pushes you to general surgery (although true general surgeons are a dying breed) or anesthesia or OB/GYN (if you are okay with only taking care of women).

 

[percyeye]

Non-MD practitioner here. How often is it that people go into medical school and have no idea what type of field they want to go into?

It seems like a huge life commitment and financial commitment to jump into not having any idea what you want to do. I understand you can try out different specialties as you go along to see if any interest you, but it seems strange to strive to go into medical school without having at least something in mind.

 

[DrMcCoyDO]

Non-MD practitioner here. How often is it that people go into medical school and have no idea what type of field they want to go into?

It seems like a huge life commitment and financial commitment to jump into not having any idea what you want to do. I understand you can try out different specialties as you go along to see if any interest you, but it seems strange to strive to go into medical school without having at least something in mind.

There’s nothing wrong with having something in mind (although many actually don’t have any idea past wanting to treat patients); however, not keeping an open mind going into school, and in particular clinical rotations, is a bad idea. I’m one of the rare few (I think) that had a decent idea of what kind of a physician I wanted to be going in, kept an open mind, but still ended up matching into the field I thought I would when I started. One of my roommates first year was confident he wanted to be a cardiologist; he’s starting his anesthesia residency this Summer.

 

[Donald Juan]

Non-MD practitioner here. How often is it that people go into medical school and have no idea what type of field they want to go into?

It seems like a huge life commitment and financial commitment to jump into not having any idea what you want to do. I understand you can try out different specialties as you go along to see if any interest you, but it seems strange to strive to go into medical school without having at least something in mind.

I would venture the majority come in relatively undecided. Even those who "know" what they want will probably change their minds. All you have to know is you want to be a doctor (read: blind ambition), and there is so much variety between different specialties most people can find something that meshes with them.

 

[ndafife]

Non-MD practitioner here. How often is it that people go into medical school and have no idea what type of field they want to go into?

It seems like a huge life commitment and financial commitment to jump into not having any idea what you want to do. I understand you can try out different specialties as you go along to see if any interest you, but it seems strange to strive to go into medical school without having at least something in mind.

There is a big difference in knowing "I want to be a doctor" and knowing what type of doctor you want to be. Insinuating that someone has no idea what they want to do is disingenuous. I knew what I wanted to do, I wanted to be a doctor.

 

[spacegun]

Hi all,

So I am a rising third year medical student who has no idea what specialty I want to do. I was thinking IM, FM, or EM in second year but truthfully I have not much clinical /shadowing experience in surgical specialties so I guess I shouldn't completely rule those out

Was anyone else in this situation before third year? I am nervous because I know for some specialties , research and other ECs are essentially required in the field

How did you go about deciding what specialty to enter?

I am doing family medicine first when I start back mid-May
I took my Step 1 exam last month and did reasonably well (250) .

250 Step 1? Just do derm and have a good life and pay. I know, I know, only if you actually like derm, but still at least it should be a specialty for you to consider liking.

 

[sanfran256]

250 Step 1? Just do derm and have a good life and pay. I know, I know, only if you actually like derm, but still at least it should be a specialty for you to consider liking.

Isn't the dermatology Step 1 score near 260 now? That's what a friend of mine told me.


I didn't think I would do as well on Step 1 as I did so I never considered it, but I think the skin is gross so I think its a no-go haha

 

[spacegun]

Isn't the dermatology Step 1 score near 260 now? That's what a friend of mine told me.


I didn't think I would do as well on Step 1 as I did so I never considered it, but I think the skin is gross so I think its a no-go haha

I'm looking at Charting Outcomes, it's 2016, but I think that's the latest one we have, and in 2016 average Step 1 was 249 for derm. I doubt it's gone up 11 points since then, but maybe. Still, it's just the average, and 250 would still put in contention. You'd have a chance assuming everything else is good.

But ya if you don't like it, then I mean don't do it. But maybe you could learn to like it? Seriously, MGMA 2016 says derm averages $434K, probably for a lot better hours than almost all the other specialties that make more than it or near $434K (I heard 40 hours is possible), regular hours with minimal if any call so you really don't have to go in at night or weekends. And I keep hearing how people change priorities and what they like in a specialty after they get married and have kids. All the cool and exciting specialties like cardiothoracic surgery, emergency medicine, interventional cardiology, critical care are fun, but once you have a family, then you might want to spend more time with your family than at work. But what do I know because I really like critical care a lot and am probably going to do critical care lol.

 

[FFH]

don't know which one you don't hate or don't know which one you love the most?
either way, this post might help. It's not specifically about residency choice, but the idea is solid. Focus on things that you can't compromise or you'll not be satisfied.
https://waitbutwhy.com/2018/04/picking-career.html

 

[BigRedBeta]

Non-MD practitioner here. How often is it that people go into medical school and have no idea what type of field they want to go into?

It seems like a huge life commitment and financial commitment to jump into not having any idea what you want to do. I understand you can try out different specialties as you go along to see if any interest you, but it seems strange to strive to go into medical school without having at least something in mind.

Super common to go in with only vague ideas. And just like choosing a major in undergrad, there is a lot of people who change multiple times before they are done. Further still, there are many people who enter IM or peds or general surgery residency with intent to further subspecialize but only have it narrowed down to 3 possibilities. They will figure it out as they actually work through those fields as residents.

Very few undergrads have any experience with the OR, or even inpatient medicine when they start, let alone have enough nuance to understand why they might prefer urology over ENT, or cardiology instead of critical care. Whole fields like PM&R suffer from graduating medical students not getting enough exposure to the field, so it's unreasonable to expect that college students would. Sometimes students have a life-changing epiphany the first time they help deliver a baby or see a trauma resuscitation in the ED.

Lastly because of the impact of grades and step 1 scores on your ability to match into many fields, incoming students have no idea what fields will even be realistic options for their futures until they reach the M3 year.

 

[curiousneuro]

Non-MD practitioner here. How often is it that people go into medical school and have no idea what type of field they want to go into?

It seems like a huge life commitment and financial commitment to jump into not having any idea what you want to do. I understand you can try out different specialties as you go along to see if any interest you, but it seems strange to strive to go into medical school without having at least something in mind.

I knew I wanted to be a doctor. Exactly what type of doctor? I had some ideas, but I knew that until I do rotations in specific subspecialties (as well as learning all the details of that organ system as well, of course) I wouldn't have a clear idea. I actually went into medical school thinking I definitely wanted to be a cardiothoracic surgeon - because that's is what I was exposed to in my pre-med shadowing opportunities. Turns out I hated the OR in med school!

Medical students (and of course pre-meds) really can't make informed decisions about specialty choices until they hit the wards in 3rd year...