Picking a speciality

[Slevin]

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I'm trying to figure out what speciality I want to go into and use my electives to give me a chance to see these specialities first hand. But I'm not sure how to go about evaluating and picking a speciality.

After talking with some of the docs on rotations I'm worried about picking a speciality that will slowly have the midlevels creep up and cause a shortage of jobs for physicians, I'm looking at Anesthesia where CNRA's have an upward trend, FM, IM, EM, etc.

I do like the 3 months I've spent on my general surgery rotation and I know I don't like Peds after my peds rotation and the OB doc suggested that I try for neurosurgery but I don't know. I'm up in the air right now on how to go about picking a speciality. Does anyone have advice on how to pick a speciality or are there books I can use?

Thanks

 

[ThePursuit]

I think part of it is a process of elimination. It's easy to start off eliminating things you really know you DON'T want to do. You've already started doing this.

Next I would list the 3 most important things you want (lifestyle, compensation, type of practice, type of patients etc.), followed by a few other, less important attributes (stereotypical people that are interested in said fields etc.). Then, spend as much time as you can reading about and talking with people in the 2-4 fields that interest you the most.

As an example, it sounds like you don't really know how to take an OB Docs recc of neurosurgery because you really don't know enough about neurosurgery as a field. Skim the forums etc. on the field, look at the procedures that will be the "bread and butter" etc.

Hope that helps.

 

[PokerDoc]

try looking at things more generally.

i know its easier said than done, but for me for example.. i know I want to do something that is 'procedurally based'. so that rules in IR, Surgery, Neurology, etc.. and it rules out a lot of diagnostic type specialties.

 

[MDpride]

I'm trying to figure out what speciality I want to go into and use my electives to give me a chance to see these specialities first hand. But I'm not sure how to go about evaluating and picking a speciality.

After talking with some of the docs on rotations I'm worried about picking a speciality that will slowly have the midlevels creep up and cause a shortage of jobs for physicians, I'm looking at Anesthesia where CNRA's have an upward trend, FM, IM, EM, etc.

I do like the 3 months I've spent on my general surgery rotation and I know I don't like Peds after my peds rotation and the OB doc suggested that I try for neurosurgery but I don't know. I'm up in the air right now on how to go about picking a speciality. Does anyone have advice on how to pick a speciality or are there books I can use?

Thanks

how competitive is ur board score?
take that into consideration.

 

[CyberKnife19]

Definitely consider the patient population that you would like to work with. For me, I knew that I had to work with cancer patients b/c I have the most sympathy for them and they are often the most appreciate and compliant patients.

 

[vicinihil]

List what you value most in life and find one that incorporates all that. Student doctor is a great place to start researching on what people in the field have to say about the field and other fields. For example: I value time with loved ones, lifestyle , not have to be in the OR much, clinic, and good pay

so right now, I'm considering Optho, Rads/IR, Cards/Interv Cards then that list may change later when I step foot into those fields and not like what they do...etc etc

 

[BigRedBeta]

Answer the big questions first:

Surgery vs no surgery
(if no surgery then lots of procedures vs few procedures is question #2)

Kids or adults or both (or only women?)

Lots of clinic time or lots of hospital time

You answer those three (or four) questions and I can point you to specific medical specialties.

If you're a surgery person, then it comes down to the types of surgeries. As a non-surgery person, I'm more limited in terms of my ability to help you sort out various surgical subspecialties.

As for the influx of midlevels, keep in mind that there are many different ways in which midlevels come into play. Degree of specialization, academic vs private practice, and other variables play significant roles. In many academic institutions the midlevels function at the same level of residents so they have lots more supervision than if they were to be in private practice. If your an interventional cardiologist, then the midlevels may be there to do post-procedure care/clinic follow up, thus freeing you up for more time in the cath lab. Thinking of them always as "competition" or replacements may not be accurate in many cases.

 

[vicinihil]

Little to no surgery

more procedures

Love clinic >>> hospital

All patient populations

Any insight?

 

[MJB]

Little to no surgery

more procedures

Love clinic >>> hospital

All patient populations

Any insight?

That pretty much screams FM.

 

[badasshairday]

That pretty much screams FM.

Not enough procedures unless you do full scope in small towns or rural locations. But it does hit all the other requirements.

I'd say GI.

 

[vicinihil]

how extensive is the surgerical exposure in Optho? I haven't done a rotation yet but I hear they do a lot of clinic and as much surgery as you want. What do you guys think?

 

[2012mdc]

Not enough procedures unless you do full scope in small towns or rural locations. But it does hit all the other requirements.

I'd say GI.

Sounds like GI to me. Also Derm sounds like an option as well. It's only a guess but I guess that patient population is probably more balanced in derm vs GI

 

[BigRedBeta]

How important is it to have kids as patients?

Certainly Adult GI seems like a good fit. Most peds subspecialties are going to be academic in nature, or at least relegated to a tertiary care center, so they'll usually require being on the inpatient side of things every once in a while (though not always depending on what your colleagues want to do - some of them may love being in the hospital). In comparison, adult GI can be much more clinic based. Really all Adult versions of subspecialties are going to give you greater freedom to find your niche.

One field that is frequently overlooked for procedures is Rheum. Obviously lots of joint aspirations if that's procedural enough for you. I know of some anesthesiologists who have agreements with rheum practices to do acupuncture as well (like for fibromyalgia patients) so that's another [creative] option that I'm sure the rheumatologists could learn if they so desired. I also think there's a couple of other things they do too. The nice thing about rheum is that there are limited number of peds fellowships, so a fair number of free standing children's hospitals actually have adult trained rheumatologists on staff.

Peds Pulm is another option, plenty of bronchoscopies, and in the Peds world Pulm is separate from the Critical Care aspect (unlike most adult fellowships), so far more clinic based. Asthma, Cystic Fibrosis and technology dependent children are managed from the largely from the clinic.

Adult Cards might also be an option...maybe more EP based for more clinic based practice? Not being an IM resident though, I can't give you much beyond speculation. One option might also be adult care of congenital heart defect patients. That's a growing area as our ability to treat and care for crazy congenital defects improves. Would still be primarily adults, but you'd get your patients through that transition period of late adolescence into early adulthood.

I think the biggest question you need to answer at the moment is which age group is most important to you. The advice I got when trying to decide on peds vs med/peds vs med (which I think with your non-surgical and clinic preference is where the answer lies), is that you should only do med/peds if you absolutely can't live without both age groups. If one is merely just a nice bonus, then you should just go with the ages that are the absolute must have.

In terms of the Family vs Med/peds debate. It comes down to whether you want OB. If doing the OB portion is not in your plans, you should do Med/Peds. Even if you're going to do OB, but don't see yourself living in a small town, you should probably do Med/Peds as no FP doc in a big city does OB. Your training will be more complete in Med/Peds, and you'll have far more fellowship options than if you do Family.

 

[surftheiop]

Little to no surgery

more procedures

Love clinic >>> hospital

All patient populations

Any insight?

What about outpatient PM&R?

 

[MJB]

How important is it to have kids as patients?

Certainly Adult GI seems like a good fit. Most peds subspecialties are going to be academic in nature, or at least relegated to a tertiary care center, so they'll usually require being on the inpatient side of things every once in a while (though not always depending on what your colleagues want to do - some of them may love being in the hospital). In comparison, adult GI can be much more clinic based. Really all Adult versions of subspecialties are going to give you greater freedom to find your niche.

One field that is frequently overlooked for procedures is Rheum. Obviously lots of joint aspirations if that's procedural enough for you. I know of some anesthesiologists who have agreements with rheum practices to do acupuncture as well (like for fibromyalgia patients) so that's another [creative] option that I'm sure the rheumatologists could learn if they so desired. I also think there's a couple of other things they do too. The nice thing about rheum is that there are limited number of peds fellowships, so a fair number of free standing children's hospitals actually have adult trained rheumatologists on staff.

Peds Pulm is another option, plenty of bronchoscopies, and in the Peds world Pulm is separate from the Critical Care aspect (unlike most adult fellowships), so far more clinic based. Asthma, Cystic Fibrosis and technology dependent children are managed from the largely from the clinic.

Adult Cards might also be an option...maybe more EP based for more clinic based practice? Not being an IM resident though, I can't give you much beyond speculation. One option might also be adult care of congenital heart defect patients. That's a growing area as our ability to treat and care for crazy congenital defects improves. Would still be primarily adults, but you'd get your patients through that transition period of late adolescence into early adulthood.

I think the biggest question you need to answer at the moment is which age group is most important to you. The advice I got when trying to decide on peds vs med/peds vs med (which I think with your non-surgical and clinic preference is where the answer lies), is that you should only do med/peds if you absolutely can't live without both age groups. If one is merely just a nice bonus, then you should just go with the ages that are the absolute must have.

In terms of the Family vs Med/peds debate. It comes down to whether you want OB. If doing the OB portion is not in your plans, you should do Med/Peds. Even if you're going to do OB, but don't see yourself living in a small town, you should probably do Med/Peds as no FP doc in a big city does OB. Your training will be more complete in Med/Peds, and you'll have far more fellowship options than if you do Family.

Internist?