Please help me in choosing a subspecialty

[Relaxo]

Hey everyone,
I'm a lowly intern and am trying to figure out a subspecialty b/c i like to be the expert in a field....the problem is, I like everything i do but not enough to want to do it for the rest of my life (which is one of the reasons i did internal medicine and not O.B. or psych). I enjoyed my rheumatology and geriatric months as an M-4 and am enjoying my renal house month now. It seems like I may like that type of patient- an older pt with chronic disease or pain. The Type A personality in me likes cardiology a lot as well. I have no experience yet in G.I. or heme-onc. I've talked to a ton of people and I guess the only 2 specialties I can cross off (even though i liked doing them) are I.D. and Pulm/C.C. How can I narrow my choices?
Thanks for any input

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[BStein76]

Hey everyone,
I'm a lowly intern and am trying to figure out a subspecialty b/c i like to be the expert in a field....the problem is, I like everything i do but not enough to want to do it for the rest of my life (which is one of the reasons i did internal medicine and not O.B. or psych). I enjoyed my rheumatology and geriatric months as an M-4 and am enjoying my renal house month now. It seems like I may like that type of patient- an older pt with chronic disease or pain. The Type A personality in me likes cardiology a lot as well. I have no experience yet in G.I. or heme-onc. I've talked to a ton of people and I guess the only 2 specialties I can cross off (even though i liked doing them) are I.D. and Pulm/C.C. How can I narrow my choices?
Thanks for any input

I am an even lower medical student applying for categorical programs looking to be a lowly intern somewhere. Like you I enjoyed my electives in medical school and will try to do those services again as a PGY-2 (or use it for what little elective time I have as an intern) before I have to start applying for fellowships. Since I know nothing about you nor have never met you; I would feel guilty about giving you bad advice about fellowships.

However I offer this observation: at some of the programs, some residents are delaying entering a fellowship (either because they are undecided, need a break or need to make money) by working as a hospitalist for 1 year after PGY-3 at the same program they trained at. This gives them some time as a PGY-3 to explore fellowship options and apply later (instead of applying in your PGY-2 year). Plus you can make some extra bucks before you get knocked back down to the PGY-4 salary.

Again I am a medical student so you probably know much more stuff about individual fellowships than I do, but I hope this hospitalist option is something you can consider. Otherwise you can make an informal survey sticky and have everyone vote (I suspect cardiology and GI will get the most votes). They used to offer those "career tests" in college where you answered a hundred questions and a computer would decide what career fits your personality; maybe they should do the same for fellowships

 

[Mumpu]

If you like everything, why not do everything and remain a general internist? If you are afraid of becoming a PCP (do you really believe that specialists are not PCPs? a lot of cardiologists function as such, for example), you can always do hospitalist medicine as a career (my choice). I know many general internists who can just about match specialists in their knowledge, except they can do it for most specialties, not just one.

 

[Relaxo]

If you like everything, why not do everything and remain a general internist? If you are afraid of becoming a PCP (do you really believe that specialists are not PCPs? a lot of cardiologists function as such, for example), you can always do hospitalist medicine as a career (my choice). I know many general internists who can just about match specialists in their knowledge, except they can do it for most specialties, not just one.

Well, there's always the danger of being replaced by a NP or whatnot...plus, even though I kinda like most of my months, I haven't come across anything I really feel strongly about except that I like patient contact and would like to be the expert/consultant on a patient...with some procedures if possible....maybe a rheumatology specialist with joint aspiration/injection clinic once a week as well?? We shall see. I think it may be the fear of going into a specialty that I'm not 100% certain about that I'm afraid of.

 

[Anthony328]

Well, there's always the danger of being replaced by a NP or whatnot...plus, even though I kinda like most of my months, I haven't come across anything I really feel strongly about except that I like patient contact and would like to be the expert/consultant on a patient...with some procedures if possible....maybe a rheumatology specialist with joint aspiration/injection clinic once a week as well?? We shall see. I think it may be the fear of going into a specialty that I'm not 100% certain about that I'm afraid of.

I matched in Rheum. I was always truly enthusiastic to see patient after patient in the rheum clinics, a lot of variety (less likely to see the same thing over&over ie scleroderma vs ra vs sle vs various sponylarthopathy vs overlap syndromes vs really rare dxs and so on), didnt mind when the pager went off to see a consult, loved the patients(very appreciative...and actually take their meds!), very progressive field with lots of potential, not to mention the job opps available when Im done in only 2 additional years. Fellowship salary not much of an issue as there is plenty of time to moonlight during the fellowship(know of fellows who supplement their income by several G/month by doing a night here/there).

My anecdotal advice....if you're on a particular rotation/elective and find yourself cringing when your pager goes off, if you'd rather argue with the person requesting a consult than seeing the patient, if you curse to yourself when you see the nurse vitaling yet another paitent when you thought you were done for the day...then maybe thats not a field you should consider spending the rest of your life in...

 

[Relaxo]

I matched in Rheum. I was always truly enthusiastic to see patient after patient in the rheum clinics, a lot of variety (less likely to see the same thing over&over ie scleroderma vs ra vs sle vs various sponylarthopathy vs overlap syndromes vs really rare dxs and so on), didnt mind when the pager went off to see a consult, loved the patients(very appreciative...and actually take their meds!), very progressive field with lots of potential, not to mention the job opps available when Im done in only 2 additional years. Fellowship salary not much of an issue as there is plenty of time to moonlight during the fellowship(know of fellows who supplement their income by several G/month by doing a night here/there).

My anecdotal advice....if you're on a particular rotation/elective and find yourself cringing when your pager goes off, if you'd rather argue with the person requesting a consult than seeing the patient, if you curse to yourself when you see the nurse vitaling yet another paitent when you thought you were done for the day...then maybe thats not a field you should consider spending the rest of your life in...

Agreed! Well, I can take general internal medicine off of that list then b/c I cringe/hate when the pager goes off from the E.R. trying to admit another patient. Hey anthony328, I know that rheum has a great lifestyle....does it pay well (i.e. about endocrine/i.d....everyone tells me that it is increasing in reimbursement secondary to the new drugs)

 

[inositide]

Does anyone know how the changing medicare reimbursement policies will affect heme/onc incomes?

As far as ruling out pulm/CC, I hear that there is shortage of them in many regions. Anyone care to comment?

For geriatrics, ask yourself if you truly want to work with the elderly population all the time. For some people, it might make life things a little glum.

 

[Anthony328]

Agreed! Well, I can take general internal medicine off of that list then b/c I cringe/hate when the pager goes off from the E.R. trying to admit another patient. Hey anthony328, I know that rheum has a great lifestyle....does it pay well (i.e. about endocrine/i.d....everyone tells me that it is increasing in reimbursement secondary to the new drugs)

To be honest it varies by region, practice. Im aware of rumors that rhematologists dont make bank vs other fields and this may be true, but it all depends on what you consider a low salary and lifestyle(ie my brother who went through nearly as much school/training as I have in the field of Architecture/civil engineering and is looking at typical starting salary <50G/yr!!!). Ive kept close tabs with fellows here and elsewhere, jobs are abundant, and average offered starting salary outside California was 200G +. From what Ive heard, highest rheumatologists/capita in San Diego, lower wages all over California. One of our academic rheumatologists recently left the program and formed a private practice with a few other people in area, now making close to 2X what he was making in academics...was ~130G/yr(varied with grants etc). I was told that regions with higher #medicare patients tends to pay out lower/patient~reimbursment(which tends to be a fact across all fields). Also keep in mind, call tends to be minimal(least taxing) vs other fields hospitalist/cards/pulm/nephrology. Next time you see a rheum fellow, ask him/her about their call....and watch the smirk on their face. Try and recall the last time you saw a rheumatologist lurking around the ER/hospital at odd ours...vs other subspecialists .
Enough of my rambling..for more info on the field...

http://www.rheumatology.org/students/faq.asp

 

[Relaxo]

To be honest it varies by region, practice. Im aware of rumors that rhematologists dont make bank vs other fields and this may be true, but it all depends on what you consider a low salary and lifestyle(ie my brother who went through nearly as much school/training as I have in the field of Architecture/civil engineering and is looking at typical starting salary <50G/yr!!!). Ive kept close tabs with fellows here and elsewhere, jobs are abundant, and average offered starting salary outside California was 200G +. From what Ive heard, highest rheumatologists/capita in San Diego, lower wages all over California. One of our academic rheumatologists recently left the program and formed a private practice with a few other people in area, now making close to 2X what he was making in academics...was ~130G/yr(varied with grants etc). I was told that regions with higher #medicare patients tends to pay out lower/patient~reimbursment(which tends to be a fact across all fields). Also keep in mind, call tends to be minimal(least taxing) vs other fields hospitalist/cards/pulm/nephrology. Next time you see a rheum fellow, ask him/her about their call....and watch the smirk on their face. Try and recall the last time you saw a rheumatologist lurking around the ER/hospital at odd ours...vs other subspecialists .
Enough of my rambling..for more info on the field...

http://www.rheumatology.org/students/faq.asp

Thanks Anthony328, I enjoyed my rheum month as a student and will have it as a resident in july....clinic based practice along with getting to do joint injxns/aspirations sounds very appealing and rheum is definetly is among my top choices right now, ....I still have to see if I like G.I. and renal....mind if I p.m. you sometime to see how fellowship is going?

 

[Anthony328]

Thanks Anthony328, I enjoyed my rheum month as a student and will have it as a resident in july....clinic based practice along with getting to do joint injxns/aspirations sounds very appealing and rheum is definetly is among my top choices right now, ....I still have to see if I like G.I. and renal....mind if I p.m. you sometime to see how fellowship is going?

sure, PM me anytime