Orthopedic Surgery vs. Anesthesiology vs. Internal Medicine

[CuriousMDStudent]

I am a MS3 debating which of these three specialties to pursue. It's still early on but wanted to give people my thoughts and perceptions of these specialties to see if people can show me a different perspective or what they think might be a good fit.

Context:
MS3 at a T15 medical school that is true P/F. Passed all of his classes. Passed STEP 1. No fails, remediation, or retakes on my transcript. I have varied extracurricular activities that span volunteering, community service, and clinical experiences during my first two years. For research, I have one fifth author ortho pub and 2 conference presentations. And I have 5 other (4 second author and 1 first author) ortho projects that are complete and in the process of being submitted to journals. I plan to work on submitting them throughout my third year but do not plan to take on any more research. I have only finished one clerkship so far which was family medicine and will most probably end up with a high pass on it. I am a good student and hard worker but family medicine was a very tough clerkship to have as my first. Currently on internal medicine and trying my hardest to get honors and learn from my mistakes in family medicine.

Orthopedic Surgery:
For the longest time during medical school, orthopedic surgery was my top choice. When I entered medical school, I wasn't sure what I wanted to do but figured I should do research in a competitive field that interests me in case I want to do it. I scoped out dermatology, orthopedic surgery, and opthalmology. Eye balls scared me and the lifestyle in skin was appealing but skin just didn't seem interesting enough to me. My medical school is a top program and well known for orthopedic surgery and is a powerhouse. Getting research was ridiculously easy and I was welcomed by mentors as opposed to dermatology and other fields where I felt I had to do beg to even get a reply from someone. Got on a project early on and started shadowing the field and learning more and the field appealed to me. I came to medical school to help people. My mentor is a hip and knee replacement surgeon and seeing him give these people back their mobility was amazing and beautiful. Surgeries were only 1-2 hours for him max and didn't seem grueling. Working on ortho projects and just seeing people improving in mobility got me interested.

Overall, I ended up liking ortho because I liked the idea of being a surgeon without having to do grueling surgeries that last 10+ hours. I liked that it was both clinical and surgery. A mix. They evaluate patients and try a lot of non-surgical treatments before they attempt surgery so you can still practice medicine in a clinic while also getting to do surgery. A variety to work. Patients are happy and genuinely want to improve their lives and are thankful for the work you do. And the pay and prestige are not bad. I know it'll be frowned upon to say that but I have dedicated so many years of schooling and am in hundreds of thousands of dollars in loans. I am not in this just for the money but I don't think I am wrong to want a return on investment for all the years of stress, sacrifice, and hard work I've dedicated to medicine.

I am considering this field a lot because I've dedicated so many hours to showing my interest in it through research. I also think I have a good shot at it. I don't have that many publications and I'm sure there are people out there with 20+ pubs in this field. But fingers crossed that at least 1-2 of my pubs come out. I have a unique personal story that I think will really set me apart and I know someone who had a similar story and 2 second author pubs from my school and great step scores end up succeeding heavily in matching in it.

I am having doubts about orthopedic surgery for several reasons though. One, I don't like how competitive the match is as so many people go unmatched. I don't know if I'll need to do a research year but I would rather be a doctor in another specialty than need to take a year to grind out research. Research is not why I decided to become a doctor. Patient care is and I don't want to spend a year doing just research. Second, the residency and lifestyle is scaring me. When I came in, I was this young buck who wanted to aim for the best. But the grind is getting to me. I want to have a family. I want to enjoy life. Seeing people die in the hospital makes me realize that things happen and I want to start enjoying life and travelling and spend time with my family and loved ones. I don't just want to endlessly grind away at work. The residency is intense for surgical specialties. I was always told ortho has a better lifestyle than the other surgical specialties but still I'm not sure. Finally, I'm not the prototypical ortho bro. I get along fine with all the personalities and surgeons and residents I've met with. I like the bro culture. But I'm not some ex nfl player who lifts 500 lbs that injured his achilles and ended up doing ortho. And a lot of the residents I met with aren't like that either but like I just feel there's this stereotype that ortho surgeons are these giant jocks and I'm not. I'm tall and relatively fit but I can't lift 500 lbs and I'm not a jock. I'm kinda nerdy tbh. The strain of the job scares me too as it can be physically demanding and I worry that I won't be able to keep doing it at an older age. The field is also not very "hand-holding". My mentors are nice but I had to ask for mentorship and will essentially be begging for a residency position vs other fields that are less competitive that may be a little chiller to get a position.

Anesthesiology:
I started considering anesthesiology during my second year. Realizing how competitive ortho can be, how hard the lifestyle and residency of ortho could be, and attending an anesthesiology workshop made me look more into the field. I liked the procedural aspect of anesthesia a lot. Central lines and intubations were so cool to me. The head of anesthesia at my school noticed my enthusiasm and interest and we got to talking and scheduled a meeting to talk more afterwards. He agreed to be a mentor to me and told me how he'd be willing to make calls for me in the future. He reassured me about CRNAs and told me the importance of doing an anesthesiology fellowship. The pay is good and comparable to ortho in some fields. The lifestyle is freaking amazing and the hours I hear some of these anesthesiologist work makes me heavily consider the field. Also it doesn't seem to be as physically demanding as ortho and I might be able to do it for a long time. If I were to do it I would likely do pain management as I would get to be in charge of my own patients and help them.

The issue I have with this field is frankly and stupidly my ego. I don't know if I could handle being bossed around in the OR or even belittled by surgeons. The head at my school told me he experienced that sometimes it happens but it depends on the surgeons. Just the idea of going through almost 13 years of training (college+med school+residency+fellowship) and being annoyed or bullied by surgeons just bugs me. Like I know I'll always be bossed by the head of my department or hospital admin but at least in ortho I'd be in charge of my own patients or the OR and be the leader during those moments. That leads to another concern of mine which is that I won't be able to get to know patients and take care of them. Like I would be intubating them and getting them through surgery but it doesn't feel as significant as being in charge of patients. I am considering pain management but I hear the patients are always not happy and can be ungrateful because you might not be able to help their pain as much as you'd like.

Internal Medicine:
Internal Medicine was my first love. My PCP was amazing and why I wanted to go into medicine. I get to be in charge of my own patients. But the lifestyle, money, and prestige deter me. I'm currently on IM and seeing so many specialties ignore consults from IM and just how long the hours are for the pay they get is not what I want. Finally the fact that I worked so hard and I'd be looked down on by my field just makes me sad. But I love the fact that I get to be there for patients truly and be there for them and being their main care manager.

This was a long post and frankly I'm laying it all out there. Thank you so much if you read through all of this and have the time to respond with a thoughtful response. I thought about shortening this post but honestly I'd rather get fewer responses from people who were willing to read and consider my thoughts vs more responses from a shortened post that didn't paint the full picture.

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[voxveritatisetlucis]

One, I don't like how competitive the match is as so many people go unmatched.

From a top 15 school?

Also why not just do ortho and one of the others as a backup. Assuming interview stay virtual, cost is a limited concern

 

[Davidfromcali]

From a top 15 school?

Also why not just do ortho and one of the others as a backup. Assuming interview stay virtual, cost is a limited concern

I go to a T5 school and we have people go unmatched in ortho, urology, neurosurg, derm ect.

No school can guarantee a match

 

[voxveritatisetlucis]

I go to a T5 school and we have people go unmatched in ortho, urology, neurosurg, derm ect.

No school can guarantee a match

Do you think this is a case of only applying to top programs?

 

[DarkHorizon]

Sounds like you are at Cornell and have mentors at hospital for special sons. Ortho is definitely competitive but it can get Uber cutthroat at a place like HSS. I’d still pursue ortho, you have a lot going for yourself. You’re very likely to match from what you have stated. You don’t necessarily have to attend residency at HSS type of place. There are many community programs that will make you a very competent surgeon. The best program is where you match.

 

[Gilakend]

M4 applying soon, very similar position to you in terms of the "context" portion of your post, switched from ortho to anesthesia recently. Can give my 2 cents on some of your points, which obviously will be biased towards anesthesia, but I think I would be happy in ortho too. I agree with most of what you wrote. IM is one of the last specialties I would pick so unfortunately I can't provide any help with that decision.

Ortho concerns:
I was essentially set on joints so I see exactly where you're coming from. I loved the outcomes but half of my days being ortho clinic seemed like a huge downside to me. However, I think your concerns about your personality/hobbies aren't a real issue. This was actually one of the things that drew me to ortho, but it turns out, that people who go to medical school are nerds. It was shocking the number of times ortho people would talk about the most extreme minutiae of bone remodeling or healing or infection risks (very important and obviously something they should know, but something I was hoping to go into ortho to avoid). Additionally, for me, it was way more refined than I thought it would be. I wanted to do it for the human carpentry aspect and was a little disappointed with the actual surgeries, which reminded me more of my core surgery rotation than wrenching on something or being in a woodshop.

Completely agree with everything you stated about the potential downsides. Matching is horrible, even from top schools. I was told by our med student ortho advisor "if not matching would make you consider another specialty, I think that's a sign not to do ortho". For the record, I 100% disagree with this, but think it provides some context into how certain people in the field feel towards commitment to the specialty. In terms of lifestyle, ortho does seem to be one of the surgical specialties where it is more realistic to find a job that fits your lifestyle requirements if you are willing to compromise on pay and be open to a variety of practice locations. But don't ever expect it to be like anesthesia.

I genuinely think I could be happy in ortho, but my personal life is the most important thing to me and I felt it jeopardized that. But if you are okay with the lifestyle, don't mind the clinic, and enjoy the procedures, after residency you really could probably make it what you want.

Anesthesia concerns:
Matching is way easier, but it is "getting more competitive" which is something you will see about 90% of specialties every single year. While the stats are trending up, they are miles better than ortho. You'd still have plenty of time to get anesthesia research if you wanted it and to make some connections in the department. Overall, you could be likely poised to match at a T20 program or higher if you wanted to.

In terms of being the "boss", the surgeon obviously dictates a lot about the OR when things are going smoothly and oftentimes needs to in order to provide the best patient outcomes. But this is very different than being solely in charge of the patient or being the "boss" of the anesthesiologist. The patient is the responsibility of both physicians. The anesthesiologist is 100% in charge of keeping the patient safe and alive during the surgery. Watch a code or unexpected complication in the OR and you will see the dynamic instantly shift. Who the "boss" is largely determined by who needs to be dictating the workflow of the OR in order to provide the best outcome. When things are going smoothly, this is usually the surgeon. When they aren't, it's the anesthesiologist. Pain obviously would let you switch roles, but again does not give you magic control over everything. It's still a surgery that would require someone else to provide anesthesia.

As for prestige, in my experience, you simply will not be as appreciated as a surgeon in my experience. If this is a big factor for you I would strongly consider looking at another specialty. A lot of times you have to be happy people don't remember you and think your job is easy because it means you're doing it right. However, this to me is very different than being disrespected or belittled, especially by someone who has no authority over you. If you let that happen, it will happen to you in any specialty you choose, not just anesthesia. You have to know when to tell people to **** off or kick rocks, no matter what specialty you go into.

As for lifestyle, I would definitely be cautious about assuming pay is similar. Can it be? 100%. Is it typically? No way. MGMA percentiles for these are miles apart and while you can make great money in anesthesia, that same amount of time in ortho would make you much more. That being said you'll still make great money and from what I've seen 400-600 for a call-taking position is reasonable depending on where you live. You could also make half that and work 7-3 or work a couple of days a week. You could also work more and make more. The flexibility is something I find very desirable. Some of the highest amount of vacation time on average of all specialties, which was a big factor for me in terms of wanting to travel. Significantly easier to adjust your lifestyle based on if you want money or free time than it would be in a surgical specialty. In contrast to ortho, you get to be in the OR every day, a huge bonus for me. Minimal notes, no clinic. When you are done, you're done.


This ended up being a lot longer than I expected, but these were some of my decision points. Overall, both are great fields. You don't have a bad option (except IM /s).

 

[ortnakas]

You clearly really want ortho.

 

[Davidfromcali]

Do you think this is a case of only applying to top programs?

Not sure but I bet there are multiple factors at play.

 

[solitarius]

In short, there is a choice to be made between ortho vs. anesthesiology based on lifestyle.

Why is IM being considered at all?

 

[operaman]

I would try and focus first on what you want your day to day to be down the road. And though it’s hard, try to imagine what you’ll like when you’re in practice and nobody else around you knows or cares what you’re doing.

Sure as a surgeon I guess I’m the leader in the OR, but in reality unless I have a student or resident with me, nobody in the room has any clue what I’m doing or how well I’m doing it. Nobody is impressed; they’re just going through their workday wondering when it’s time for lunch.

Which thankfully I really like doing it and it’s nice to break up the clinic days with something different. So try and visualize what you’d enjoy once the newness wears off. Intubations and central lines are fun at first, but after you’ve done thousands of them they’re just repetitive tasks and the overall thinking and decision making is what remains interesting.

Try and get a sense of what individual attending’s weeks are like. There’s a distortion you get as a student bouncing from cool case to cool case - you miss all the uncool stuff your attendings are doing. No one attending has a practice as cool as what you see in a typical week as a student.

Overall, based on your post, I think your best bet would be dual apply Ortho and anesthesia. Both great fields and I think pain would be a good fit. Highest earning doc at my hospital in an interventional pain guy and the patients of his I’ve seen are extremely happy and they’re not on opioids so he must be doing something right!