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[fat_thrombosis]

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My chief complaint: I don't know what to do with my life.

A brief annotated history: Born/raised in SoCal, undergrad at Harvard, currently a 3rd year med student at Columbia. It's getting to be that time of year where we figure out our 4th year schedules, and herein lies the rub -- I don't know what specialty I want to go into. Rather, I can't decide among the three that I like the most: (in no particular order) anesthesia, ophtho, and ortho. I'm a pretty laid-back kind of guy, work well under pressure/not as well in the absence of, have been involved in athletics my entire life (martial arts, water polo), am the only son of fairly traditional Chinese parents and am expected to support them through old age, and I desire to live someday either back home in California or in the Boston area, where I spent my college years.

My credentials (I'll be candid even though I know some of my classmates read these forums -- wassup Scooby, hey modemduck): I did well my first year and would have honored our basic sciences/physiology course if not for our pass/fail system in our first year; I honored Pharm my second year and just passed everything else. I did uncharacteristically poorly on Step 1 (<200) and ever since then my score on that godforsaken exam has haunted me. I've risen from the ashes of that debacle and have been doing fairly well this (my third) year, getting Excellent-Outstanding's in most of my rotations but no pure Outstanding's (in Columbia P&S speak, Outstanding = Honors, and Excellent = Good try son, better luck next time).

I've done some serious soul-searching these past few weeks, all to no avail. This process of deciding what I want to do is making me surprisingly depressed. In any case, today I jotted down some of my thoughts in favor of and against each of the three specialties that I'm considering, which I've listed below. I would appreciate if any of you knowledgeable in any of these fields would provide me with advice, because as it stands, I just don't know what to do with myself. And please correct any misconceptions about these specialties that I harbor.

PS: Please forgive any brash or unseemly language/thought content.

Anesthesia
+ excellent pay for the amount of work put forth
+ acute management of patients (opportunity for codes)
+ emphasis on pharmacology and physiology, two subjects you excelled and took interest in during your first two years of med school
+ lifestyle considerations (good hours, not physically backbreaking)
+ You have better chances here to get into a good residency program; you won’t have to settle for Bumble****, West Virginia i.e. you can match at a desired geographical location (e.g. Boston/Harvard area, Southern California)
+ Your fellow residents are generally more laid-back, friendlier people.
+ At the moment, the job market is excellent – you get paid well even in so-called “saturated markets”
- You may get bored sitting back there.
- You don’t have the same amount of “respect” as does ortho/ophtho.
- Job longevity unclear; will anesthesia be taken over by techs in the future?

Orthopaedics
+ fun surgical cases
+ emphasis on sports/mechanical injuries is right up your alley, given your background in kung-fu and in team sports
+/- fellow residents are jocks (like you) but are generally Type-A dinguses (unlike you... generally)
+ You get respect (from family, from girlfriend, other subspecialties, etc)
- You will struggle to match anywhere.
- Residency is a ****load of work and stress.
+ You will get paid handsomely (according to most people)...
- ... but not in southern California (according to some attendings).
- Physically demanding (long periods of standing --> back pain)
+ Once in practice, job security is good; there will always be a need for orthopaedists
- You may get bored.
- Doing ortho will require your taking a year off for research… and even then, your chances for matching are slim.
+ Your parents want you to do this.

Ophthalmology
+ Vision/sight/the eye are fascinating
+ The surgeries are delicate, requiring finesse – which I like.
+ You get to operate sitting in a chair, sparing you from back pain.
+/- There is a question over compensation; apparently, young ophthalmologists have a rough time making money, especially in saturated markets
- You will have a difficult time matching into any program. Think Bumble****, West Virginia.
- People don’t know the difference between optometrists and ophthalmologists… and having to explain the difference to them is going to get incredibly frustrating over time. And by “them,” I mean “your parents.”
+ If you go this route, you will most likely become an academic physician, working in a university setting – which would probably not happen if you were to do anesthesia or ortho. A interesting change of pace/lifestyle.
- Doing ophtho will require your taking a year off for research… and even then, your chances are slim.

 

[doc05]

sounds like you want ophtho. doing a year of research between ms3 and ms4 is a good idea, esp for a borderline (<200) candidate. talk with an ophtho advisor at your school. The Harvard/Columbia names will carry you very far, even with the low board score. take step 2 early and rock it (>240).

ps: you can do academics in both ortho and anesthesia if it's what you want.

 

[Gfunk6]

The good news: You have an Ivy league pedigree for both undegrad and med school. This will carry a lot of weight, particularly in Northeastern institutions.

Gas is definitely still doable and probably your best bet. Ortho is tough and Optho would be extremely tough. Your best bet is to ask an academic advisor what your chances are in the latter fields. I suspect his answer will be that your chances are "slim," unless you crush Step II. Even then you need to apply broadly (40+ programs, I would guess).

All hope is not lost, but you really do need to put your best foot forward from now on.

 

[robotkiller]

Ophtho and Ortho will be extraordinarily difficult to match with that Step I unless you kill Step II early with a CV heavy in research. As others have noted, your Ivy League status will probably make up a good bit of that difference, but still. I think anesthesia is definitely an option, however.

Another option to possibly consider would be to go IM in a top notch program and go into something like interventional cardio where you get the procedures and great pay(albeit heavier work hours)

 

[BOOYAH]

what's up roommie.
i have had an equally depressing few weeks, trying to figure out if i can actually match in my chosen field. i'm pretty certain that i'm going for it though.
you have a lot to consider, dog. do what will make you happy in the long run, which includes weighing professional and personal goals. from what i've seen from you, you might not be happy in a highly labor intensive field like ortho since you value your personal life and relationships so much (unlike many of our classmates).

 

[brendang]

yeah, sounds like you're an "eye guy"... looks like you're picking gas for all the wrong reasons (at least the same reasons why my friends all chose it)... don't know much about ortho but that you'll work your a$$ off... ophtho, in my opinion is the best option regardless... you are a primary care doc, you're a surgeon, you're an anesthesiologist (in some ways, and i think retrobulbar anesthiesia is pretty wild!), a radiologist (angiograms) and you get paid well (very well with fellowships; check retina!!), work very very decent hours (except for retina 🙁 ), get big props from your buds (and by buds i mean chicks)... your step 1 score isn't a big deal... some programs will cut you right off, but it's no big deal... you sound like a funny dude so i'm sure you're do swell in the interview (and you will get an interview coming from Columbia)... Apply broadly, do some research and try to relax... this all supposed to be fun, right? 🙂

 

[souljah1]

anesthesiology included the only positive comment where you mentioned that you excelled. your reasons for ophtho were more about what other people think about you and that you can sit in a chair.

gotta go with what you are good at and what interests you for the long haul.

anesthesiology seems like the winner to me.

 

[scootad.]

please dont pick your specialty - ortho - to make mom and dad happy. how ridiculous. you hear about parents wanting their children to go to med school, law school etc. which in itself is absurd, but to tell them what field to go into! no, its not enough that your an MD, you have to be an orthopod/ophto/ent/surgeon!! what next, where to do fellowship, where to send your kids to school (public v. private v. boarding)? when does this
**** end?! you have to draw the line here, if they want you to do ortho, tell them to apply to med school!

 

[JR]

If you do well on Step II, get involved with research ASAP and get decent rec letters, I can almost guarantee you can get a good ophtho spot. Ophtho is a small field and Ivy League names with carry a lot of weight.

 

[DrBloodmoney]

Go into Path...

 

[bigfrank]

In reading this, a great deal of your reasoning involves prestige and how people will see you (mom, dad, girlfriend). I wouldn't avoid anes. based on a perceived lack of respect. Orthopods aren't exactly hallowed.

Further, hopefully your girlfriend won't really care what field you go into, as long as you're happy. If this is a problem, I'd consider finding a new girlfriend, saving you big $$$$ in the long run.

 

[pamchenko]

hey fat thrombosis, if u did your general surgery rotation at columbia during september, I think I met you while I was doing an away elective at Columbia...i was the asian kid from suny syracuse. i remember hearing about your situation. sounds like lifestyle, pay and prestige are factors in your decision...if so...here are some comments i have about the fields you've mentioned.

optho - you do NOT have to go the academic route...I thought most optho people were private. regardless, its a field where your physical exam means alot and its very definitive diagnosis unlike internal medicine...you usually have an answer for the patient. however, I don't think you'll feel like a "real doctor." you won't know how to treat common problems and won't know how to save lives really...optho is really its own little thing. what you learned in med school will go out the door.

ortho - you will work very hard in residency. the life afterwards i think will probably be as easy or as hard as you want it to be. pay i heard is excellent but that's because of the volume of cases (but harder life).

anesthesia - excellent pay, easy as f*** life, especially if you join a private group. I worked at a private hospital and saw private anesthesia attendings and they had it real cush. is it prestigious? I think it is for the general public.

regarding prestige, you have to consider the difference between being prestigious amongst peers or among lay people...a pediatrician is prestigious to many...but it isn't the most competitive thing for your peers...for me personally, I stopped caring about prestige when I realized it inversely correlated with my future happiness in terms of work.

ask yourself why you went to medical school. I went to med school to help people pure and simple and I felt that general surgery was the best way for me to do that. in a specialty field, you'll easily make enough money to live comfortably. if you marry another physician, that dual income will be huge as is.

I think out of all the fields of medicine that are lifestyle, anesthesia is the most obtainable one. rads is difficult to get, derm is very competitive, rad onc is the same way. I'd probably put emergency medicine slightly below rads in terms of hard to get.

I think that since you come from Columbia, you have a chance at ortho or optho. Even though ur board score is below average, you can still take step 2 early and try to do well on it. However, like you said, don't expect to go to a major metropolitan area for ortho or optho unless you stay @ columbia which is possible, but tough because you'll be competing with kids from other programs that are AOA with research who are your typical ortho/optho applicants that apply to columbia.

If you can deal with the boringness of anesthesia, and dont feel that you want your job to be a big part of your life as it will be mine, then by all means go to the other side of the sheet. you'll spend more time with your family, be able to provide them with financial security. you'll also be more likely to do your residency in a place where you have friends and things to do outside the hospital. you'll probably be a happier person. i think the key to making a residency decision is "what makes me happiest?" for some, it really is prestige. I say put that on the bottom of the list, its not worth the work.

 

[pamchenko]

Go into Path...

arguments against path
-its not clinical work
-its boring

 

[EVMSPeds]

I just have to say that unless you've done an ophtho rotation and loved it, I would rethink that idea. I only did 2 weeks of ophtho and was definitely looking for a gun to shoot myself in the head about 3 days into it. I agree with the guy who said that you will feel like you won't really be treating anything (other than glaucoma and strabismus.)

 

[CameronFrye]

arguments against path
-its not clinical work
-its boring

argument for path
-its not clinical work

 

[Obedeli]

This was NOT a moment of my time.! 🙄

 

[mjoo]

You ought to rebel, think outside of the box, live a little: choose psych!

 

[doc05]

arguments against path
-its not clinical work
-its boring

"it's not clinical work" is an argument FOR path.

thinking along those lines, however, are reasons against both ophtho and ortho. neither can handle any real medical problems outside their very focused areas.

 

[Doczilla]

Optho: Worry less about the income thing. LASIK is changing that, and opthos have the chance to make lots of money fixing eyes. I agree with the research comments. You need to have some connection to optho (research, former optho tech, etc) to be confident of matching. Don't sweat your parents. You will make them understand what you do. Optometrists don't do surgery. They also don't get called in the middle of the night to come to the ER and save someone from going blind, but opthos do. Those cases may be few and far between, but wow.

Ortho: You'll be beaten like a rented mule in residency. Compensation is very good. Ortho attendings like to b$tch all the way to the bank about how little they make, but don't let them fool you. You'd probably hear the same thing anywhere. Lots of procedures. Can get repetetive if all you're doing is scoping joints and replacing knees. Sports med could certainly provide a way to get out of the office and work on healthy people who aren't trying to work you for pain meds or disability checks.

Anesthesia: You get to intubate, but it seems pretty boring the rest of the time. (remember the ABCs: Anesthetist, Book, Chair) There is a certain amount of basic science to it, but after a while, it simply becomes protocol. Most anesthesiologists I've seen use the same cocktail of drugs in the same order all the time. Some variation based on instinct. Procedures such as intubation and epidurals are nice, though, as you get to use your hands a bit. Unless the code is in the OR, you'll get to intubate and that's about it. Medicine docs do the rest. You may get some challenge and variety if you become a pain specialist. Respect is there, contrary to popular belief, as you are the DEFINITIVE authority on getting the airway. Likewise don't worry about what your parents think.

Don't listen to anybody. What excites you?


'zilla